- Evolent (Tallahassee, FL)
- …the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks ... medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the… more
- Zelis (St. Petersburg, FL)
- …maintain claim review content, including but not limited to DRG Reviewer Rationales, DRG Clinical Validation Policies and Dispute Rationales + Perform regulatory ... are. Position Overview At Zelis, the DRG Clinical Dispute Reviewer role is responsible for the resolution of facility...production and quality metric goals. What you'll do: + Review provider disputes for DRG Coding and Clinical Validation… more
- Centers Plan for Healthy Living (Margate, FL)
- …For Healthy Living is currently accepting applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works ... their home to improve their quality of life. Utilization Management Clinical Reviewer will assess and process all authorization requests to determine medical… 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
- HCA Healthcare (Orlando, FL)
- …us apart from any other healthcare provider. We are seeking a(an) Registered Nurse Coordinator Bariatrics to join our healthcare family. **Benefits** UCF Lake Nona ... nurses play a vital part. We know that every nurse 's path and purpose is unique. Do you want...coordinate education and communication related to regulator updates. **CLINICAL REVIEWER RESPONSIBILITIES** : + MBS clinical reviewer … more
- Molina Healthcare (Miami, FL)
- …**Job Summary** Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory ... and reports quality of care issues. + Assists with complex claim review including diagnosis-related group (DRG) validation, itemized bill review , appropriate… more
- Actalent (Orlando, FL)
- Remote Clinical Review Nurse - Prior Authorization Location: Must be located in Central or Eastern time zones Employment Type: Full‑Time About the Role We are ... seeking an experienced Registered Nurse to join our team within a leading Managed...to gather additional information when needed. + Document all review decisions clearly, accurately, and in compliance with regulatory… more
- Actalent (Tampa, FL)
- Urgent Hiring for "Remote Clinical Review Nurses" Job Description: + Review approximately 20 cases a day for medical necessity. + Advocate for and protect ... complete cases. Qualifications: + 3+ years of utilization management, concurrent review , prior authorization, utilization review , case management, and discharge… more
- HCA Healthcare (Englewood, FL)
- …provides satisfaction and personal growth, we encourage you to apply for our Registered Nurse RN Float Pool PRN opening. We review all applications. Qualified ... you have the PRN career opportunities as a(an) Registered Nurse RN Float Pool PRN you want with your...medications and treatment instructions + You will maintain and review patients' records including posting tests and examination results.… more
- HCA Healthcare (Port Charlotte, FL)
- …Hospital we support our colleagues in their positions. Join our Team as a(an) Registered Nurse RN Float Pool and access programs to assist with every stage of your ... affordable to gain certifications and job skills. Apply today for our Registered Nurse RN Float Pool opening and continue to learn! **Job Summary and… more