- 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...provider disputes. + Utilize the most up-to-date approved Zelis medical coding sources for claim review maintenance.… more
- Elevance Health (FL)
- …+ Works on reviews that are routine having limited or no previous medical review experience requiring guidance by more senior colleagues and/or management. ... **Nurse Reviewer I** **Location:** This role enables associates to...meets medical necessity criteria or requires additional medical necessity review . + Conducts initial … more
- Evolent (Tallahassee, FL)
- …Stay for the culture. **What You'll Be Doing:** As an Occupational Therapist, Clinical Reviewer you will be a key member of the utilization management team. We can ... needed or required. Job Summary Functions in a clinical review capacity to evaluate all cases, which do not...an approval cannot be rendered to the Physician Clinical Reviewer . In States where allowed, will make denial determinations… more
- ChenMed (Miami, FL)
- …join our team. The Physician Reviewer is the primary physician reviewer for Utilization Management/Clinical Appropriateness review cases in our organization. ... Word and PowerPoint **EDUCATION AND EXPERIENCE CRITERIA:** + Graduate from accredited Medical School with a valid, unrestricted license is required + Completion of… more
- City of Coral Gables, FL (Coral Gables, FL)
- Plumbing Plans Reviewer Print (https://www.governmentjobs.com/careers/coralgablesfl/jobs/newprint/5158556) Apply Plumbing Plans Reviewer Salary $89,470.17 - ... a variety of routine and complex technical and administrative work in plumbing plans review and analysis to determine compliance with all applicable codes as well as… more
- Centers Plan for Healthy Living (Margate, FL)
- …for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works within a multidisciplinary team to help identify and manage ... in 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 ... exclusions. Conduct reviews on inpatient DRG claims as they compare with medical records ICD-10 Official Coding Guidelines, AHA Coding Clinic and client specific… more
- Evolent (Tallahassee, FL)
- …Determines medical necessity and appropriateness of services using clinical review criteria. + Accurately documents all review rationales and determinations. ... the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are… more
- Evolent (Tallahassee, FL)
- …improvement functions under the auspices of the office of the Chief Medical Officer. ESSENTIAL DUTIES AND RESPONSIBILITIES: include the following. Other duties may ... patients as directed by the office of the Chief Medical Officer. + Responsible for clinical conversations with providers...to ensure client satisfaction. + Perform all peer clinical review activities while located in a state or territory… more
- Evolent (Tallahassee, FL)
- …when available, within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the ... **What You'll Be Doing:** Job Description **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to make a meaningful… more