• Diagnosis Related Group Clinical Validation…

    Elevance Health (Tampa, FL)
    … chart coding principles, clinical guidelines, and objectivity in the performance of medical audit activities. + Draws on advanced ICD-10 coding expertise, ... and efficiency recommendations. **Minimum Requirements:** + Requires current, active, unrestricted Registered Nurse license in applicable state(s). + Requires a… more
    Elevance Health (05/22/25)
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  • Clinical Appeals Nurse ( RN )

    Molina Healthcare (Orlando, FL)
    …appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical/ medical reviews of ... of the following: + Active and unrestricted Certified Clinical Coder + Certified Medical Audit Specialist + Certified Case Manager + Certified Professional… more
    Molina Healthcare (05/16/25)
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  • RN - Prior Authorization-Concurrent

    Actalent (Sunrise, FL)
    …required + Perform other quality initiatives as necessary Skills: Quality improvement, data, audit , data abstraction, chart review, medical , quality audit , ... Actalent is Hiring Multiple Remote HEDIS RN Abstractor Description: Position Purpose: Lead data collection...and/or custom or other measure set standards + Review medical records and abstract data for HEDIS and other… more
    Actalent (05/24/25)
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  • Health Services Administrator RN

    YesCare Corp (Bartow, FL)
    …if applicable. + Bachelor's degree in healthcare administration/related field required. Licensed or Registered Nurse required in lieu of degree. + Minimum of ... compliance with allYesCareand applicable client systems and applications. + Coordinates the Medical Audit Committee and facilitates the monthly meetings. +… more
    YesCare Corp (05/06/25)
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  • RN Nurse Quality Assurance…

    Kelly Services (Lake Mary, FL)
    … Aide Evaluator programs across the United States. **Important Requirements:** Must possess a Registered Nurse ( RN ) license in good standing, with a compact ... or multi-state license OR must possess a Registered Nurse ( RN ) license in...all testing and evaluation processes. Assist in managing the audit process and the selection of Quality Assurance auditors… more
    Kelly Services (05/20/25)
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  • Revenue Integrity Clin Charge Review Analyst…

    HCA Healthcare (Ocala, FL)
    …reviews, and patient audits as needed. **Qualifications that you will need:** + Registered Nurse Degree required. + Minimum 1 year directly related Healthcare ... opportunities as a Revenue Integrity Clinical Charge Review Analyst RN you want with your current employer? We have...colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no… more
    HCA Healthcare (03/22/25)
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  • RN Nurse Lead PRN Trauma

    HCA Healthcare (Kissimmee, FL)
    …with purpose and integrity. We care like family! Jump-start your career as a(an) RN Nurse Lead PRN Trauma today with HCA Florida Osceola Hospital. **Benefits** ... colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no...vary by location._** Come join our team as a(an) RN Nurse Lead PRN Trauma. We care… more
    HCA Healthcare (05/14/25)
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  • Investigator, SIU RN -Remote

    Molina Healthcare (FL)
    …care experience. **REQUIRED LICENSE, CERTIFICATION, ASSOCIATION** : Active, unrestricted State Registered Nursing ( RN ) license in good standing. **PREFERRED ... health care fraud, waste, and abuse. Duties include performing accurate and reliable medical review audits that may also include coding and billing reviews. The SIU… more
    Molina Healthcare (04/12/25)
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  • PRN Home Infusion Nurse

    Naven Health (Tallahassee, FL)
    …+ Graduate of an accredited School of Nursing. + Current active and unrestricted registered nurse license + At least 2 years of clinical experience working ... all members of treatment team. (Naven Health's Clinical team, medical providers, patients, and families/caregivers) to facility continuity of...+ Knowledge of the scope of practice of the registered nurse and ability to apply professional… more
    Naven Health (05/21/25)
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  • Medical Auditor

    BayCare Health System (Clearwater, FL)
    …- Associates - Nursing; Preferred - Bachelors - Nursing **Credentials:** + Required - RN ( Registered Nurse ) - State of Florida **Experience:** + Required ... **Status:** Full Time, Exempt **Shift Hours:** 8 hours **The Medical Auditor is responsible for:** + Compare the detailed...donor charges, and maintain a log of all chart audit requests and the related results. + Some travel… more
    BayCare Health System (05/29/25)
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