- AdventHealth (Altamonte Springs, FL)
- …and grievances from patients; assists in drafting and submitting clinical denial appeals , as needed + Develops Medical Director relationships with payors to ... as collaborating with other disciplines to assist in the improvement of clinical documentation, patient safety, and quality outcomes. Through primary support of… more
- Growth Ortho (Tampa, FL)
- Job Title: Director of Payer Strategy & Contracting Location: Remote (with limited travel, approx. 2-4 days/month) Reports To: SVP, Revenue Cycle Organization: ... Position Summary: Growth Orthopedics (GO) is seeking a strategic and experienced Director of Payer Strategy & Contracting to lead enterprise-wide initiatives that… more
- HCA Healthcare (Port St. Lucie, FL)
- …medical consultation on contracting, pricing, and analysis of managed care issues. Offers clinical support for appeals and denials process, discharge ... Officer (CMO) ensures high quality, patient-centered care by leading clinical and quality initiatives that support the provision of...managers and hospital staff in the reduction of payer denials and in the denial and appeals … more
- AdventHealth (Orlando, FL)
- …in billing for technical component of services and appeals for denials . Provides guidance to clinical questions from Utilization Management staff involved ... life balance **PRINCIPAL DUTIES AND JOB RESPONSIBILITIES** **:** Provides clinical support/validation for Care Management, CDI and Quality teams....in authorizations, concurrent review, and denials as a back up to UM Physician Advisory… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …in utilization of resources, avoidable days/ denials . Works in collaboration with Appeals Management/Medical Director in the appeals process. + ... community resources. + Authorize services and coordinate referrals based on clinical guidelines and insurance coverage. + Provide telephonic and/or in-person case… more
- Monte Nido (Miami, FL)
- …in level of care, discharge, retrospective, facilitating peer to peer reviews, and written appeals . + Engage in clinical rounds as an active treatment team ... team approach while integrating state-of-the-art medical, psychiatric, nutritional, and clinical strategies to provide comprehensive care within an intimate home… more
- Veterans Affairs, Veterans Health Administration (Orlando, FL)
- …Fault, and Worker's Compensation cases to validate related care for reimbursement. Conducts clinical appeals as required by the third-party payers to overturn ... Nurse Manager is accountable to the Consolidated Patient Account Center (CPAC) Director , manages RUR Assistant Nurse Managers, RUR Nurses, and general schedule (GS)… more