• Denial Prevention Specialist

    AdventHealth (Maitland, FL)
    …Body, Certified Professional in Healthcare Risk Management (CPHRM) - EV Accredited Issuing Body, Registered Nurse ( RN ) - EV Accredited Issuing Body **Pay ... First Coast, SMRC Noridian, and ZPIC. + Performs pre-operative surgical reviews for high audit risk surgeries for all payers based on a specific algorithm at least 7… more
    AdventHealth (01/16/26)
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  • Second Level Reviewer I

    AdventHealth (Altamonte Springs, FL)
    …(CDIP) - EV Accredited Issuing Body, Physician Assistant (PA) - EV Accredited Issuing Body, Registered Nurse ( RN ) - EV Accredited Issuing Body **Pay Range:** ... mentoring. + Maintains regional productivity standards and demonstrates competence on compliance audit scores. + Maintains a 97% physician response rate to all valid… more
    AdventHealth (01/16/26)
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  • Call Center Quality Assurance Specialist

    AssistRx (Orlando, FL)
    …and/or financial access programs preferred. + Bilingual - Spanish preferred. + Bachelor's Degree or Registered Nurse (BSN or RN ) a plus. + COMPETENCIES: + ... Previous call center experience participating in quality call and system audit performance reviews preferred. + Previous experience in patient support/patient… more
    AssistRx (11/11/25)
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  • Inpatient DRG Reviewer

    Zelis (FL)
    …adherence to Zelis standards regarding privacy What you'll bring to Zelis: + Registered Nurse licensure preferred + Inpatient Coding Certification required (ie, ... CM, MS-DRG and APR-DRG claims preferred + Solid understanding of audit techniques, identification of revenue opportunities and financial negotiation with providers… more
    Zelis (12/27/25)
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  • DRG Clinical Dispute Reviewer

    Zelis (St. Petersburg, FL)
    …( ie . CCS, CIC,RHIA , RHIT, CPC or equivalent credentialing). + Registered Nurse licensure preferred + Bachelor's Degree Preferred in business, healthcare, ... or technology preferred. + Solid understanding of audit techniques, identification of revenue opportunities and financial negotiation with providers + Experience and… more
    Zelis (12/17/25)
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  • Director, Home Health Grievances & Appeals

    CenterWell (Tallahassee, FL)
    …us put health first** The Director Denials Management provides leadership for the audit , appeal and review process to preserve and recover revenue while maintaining ... and support to clinical and operational leadership regarding Medicare and governmental audit trends, denials, and any CMS initiative and/or demonstration projects. +… more
    CenterWell (01/08/26)
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  • Executive Director, UHealth Medical Risk…

    University of Miami (Miami, FL)
    …to reduce risk to known and acceptable levels. + Develops an ongoing program to audit all the organizational controls to ensure that they are in place and remain ... Society of Health Care Risk Management (FASHRM) desired. Medical licensure -MD, RN , ARNP, PA-is a plus.Knowledge, Skills and Abilities: + Ability to maintain… more
    University of Miami (01/15/26)
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  • Clinical Research Nurse

    HCA Healthcare (Port Charlotte, FL)
    …We care like family! Jump-start your career as a Clinical Research Nurse today with HCA Florida Fawcett Hospital. **Benefits** HCA Florida Fawcett Hospital ... location._** Come join our team as a Clinical Research Nurse . We care for our community! Just last year,...issues for guidance + Assists sponsor and US FDA audit teams + Reviews and responds to any monitoring… more
    HCA Healthcare (11/12/25)
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  • Disability Clinical Specialist

    Sedgwick (Tallahassee, FL)
    …appropriate recommendations are made on claims. + Consistently achieves appropriate quality audit scores. + Acts as clinical resource to claims examiners to provide ... **Education & Licensing** Bachelor's degree or equivalent preferred. Current RN , CRC, LPC and/or LCSW Licenses required. Current license, registration… more
    Sedgwick (10/24/25)
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