- Elevance Health (Lake Mary, FL)
- …spending. The **DRG Coding Auditor Principal** is responsible for auditing inpatient medical records on claims paid based on Diagnostic Relation Group ... (DRG) methodology, including case rate and per diem, generating highly complex audit...all lines of business, and its clients. Specializes in review of DRG coding via medical record and attending… more
- Datavant (Tallahassee, FL)
- …DX, RVU assignment, modifiers, and knowledge of NCCI edits. Chart mix includes both inpatient and outpatient. Epic 3M360 systems.** **What You Will Do:** + Review ... + Comprehensive training led by a credentialed professional coding manager + Exceptional service-style management and mentorship (we're in...reviewed by Datavant Human Resources and determined on a case -by- case basis. Depending on the state in… more
- HCA Healthcare (Kissimmee, FL)
- …with discharge planning or psychosocial needs. + You will obtain input from the RN case manager to ensure the discharge plan is appropriate and aligns with the ... you will do in this role:** + You will work collaboratively with RN case managers, acute care nurses, physicians, insurance companies, and other staff members to… more
- HCA Healthcare (Fort Pierce, FL)
- …with discharge planning or psychosocial needs. + You will obtain input from the RN case manager to ensure the discharge plan is appropriate and aligns with the ... you will do in this role:** + You will work collaboratively with RN case managers, acute care nurses, physicians, insurance companies, and other staff members to… more
- Elevance Health (Tampa, FL)
- …the state of Florida** The **Medical Management Nurse** will be responsible for review of the most complex or challenging cases that require nursing judgment, ... skills and nursing judgment and experience. + Collaborates with case management nurses on discharge planning, ensuring patient has...and requires a minimum of 2 years clinical, utilization review , or managed care experience; or any combination of… more
- Molina Healthcare (Miami, FL)
- …Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society ... * Provides leadership and expertise in performance of prior authorization, inpatient concurrent review , discharge planning, care management and interdisciplinary… more
- Elevance Health (Miami, FL)
- …policies when making medical necessity decisions. + Brings to their supervisors attention, any case review decisions that require Medical Director review or ... make an impact:** + Ensures timely completion of clinical case reviews for their board certified specialty. + Makes...3 years of clinical experience post residency. Preferably in inpatient post-acute care + Board certified in Physical Medicine… more
- HCA Healthcare (Fort Walton Beach, FL)
- …patients with discharge planning or psychosocial needs. + Obtains input from the RN case manager to ensure the discharge plan is appropriate and aligns with ... non-clinical, biopsychosocial assessments and interventions as needed for both the inpatient floors and the outpatient emergency department. The MSW performs crisis… more
- CenterWell (Madison, FL)
- …* Schedule discharge visits, OASIS Collection, recert visits, and Transfer to Inpatient Facility (TIF) OASIS collection visits. * Reschedule declined or missed ... * Prepare and edit weekly agent schedules, perform initial review for productivity/geographic issues, and forward for approval. *...issues, and forward for approval. * Assist with weekly case conferences. * Receive calls from field staff and… more