- AdventHealth (Tampa, FL)
- …collaboration with physicians, nursing and HIM coders, the Second Level Reviewer I strategically facilitates and obtains appropriate and quality physician ... complexity of care of the patient. The Second Level Reviewer I educates members of the patient care team...mortality (ROM), and quality. Completes accurate and timely record review to ensure the integrity of documentation compliance. Completes… more
- AdventHealth (Orlando, FL)
- …collaboration with physicians, nursing and HIM coders, the Second Level Reviewer I strategically facilitates and obtains appropriate and quality physician ... complexity of care of the patient. The Second Level Reviewer I educates members of the patient care team...(ROM), and quality. + Completes accurate and timely record review to ensure the integrity of documentation compliance. +… more
- Zelis (FL)
- …interests that shape who you are. Position Overview The Inpatient DRG Reviewer will be primarily responsible for conducting post-service, pre-payment and post pay ... AHA Coding Clinic and client specific coverage policies. Conduct prompt claim review to support internal inventory management to achieve greatest savings for… more
- Actalent (Sunrise, FL)
- Job Title: Behavioral Health Utilization Review NurseJob Description We are seeking a dedicated Utilization Management Nurse (UMN) who will work collaboratively ... internal process development, and provide education to the team on utilization review -related issues. Responsibilities + Review prior authorization requests for… more
- Actalent (Sunrise, FL)
- Job Title: Behavioral Health Utilization Review NurseJob Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing requests for ... with the interdisciplinary team, the UMN handles tasks related to utilization review across various specialties, medical treatments, and services. The role involves… more
- Zelis (St. Petersburg, FL)
- …Effective and proven leadership experience is a must as recommendations to the Nurse Reviewer 's regarding their claim management is required. Additionally, this ... you are. Position Overview The Sr. Supervisor, Clinical Chart Review is focused on supervising a team of Clinician's...as needed Quality Assurance and complete bi-annual assessment of Nurse Reviewer performance. Report these results to… more
- AdventHealth (Orlando, FL)
- **Quality Review Nurse RN PRN Home Care AdventHealth Home Health** **All the benefits and perks you need for you and your family:** + Benefits from Day One + ... Home Care experience + OASIS experience + PDGM experience + Registered Nurse State Licensure and/or Compact State Licensure In Florida **Preferred qualifications:**… more
- Molina Healthcare (Tampa, FL)
- …set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing clinical knowledge and experience, ... responsible for review of documentation to ensure medical necessity and appropriate...quality of care issues. + Assists with Complex Claim review including DRG Validation, Itemized Bill Review ,… more
- Centene Corporation (Tallahassee, FL)
- …discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in ... determinations or provide recommendations based on requested services and concurrent review findings + Assists with providing education to providers on utilization… more
- Actalent (Sunrise, FL)
- …+ Deliver telephonic and digital outreach to engage members in care management programs. + Educate members on dietary practices tailored to chronic conditions ... including anxiety, asthma, COPD, CHF, depression, and diabetes. + Develop and guide members through clinically indicated dietary plans to support self-management and treatment goals. + Collaborate with Community Resource Coordinators and market-level partners… more