- Centene Corporation (Tallahassee, FL)
- …flexibility. **Must Reside in Florida!** **Centene is Hiring!** **We're looking for a Remote Concurrent Review Nurse to support our Medicaid team.** **Ideal ... needed to discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member… more
- Cognizant (Tallahassee, FL)
- …and retro-authorization as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral, preauthorization, ... determinations to the Health Plan/Medical Director based on the review of clinical documentation in accordance with...have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical … more
- AdventHealth (Celebration, FL)
- …in the defeat of illness and disease **The role you'll contribute:** The Clinical Nurse Education Facilitator (CNEF) is an expert clinician, highly skilled ... thinking, critical reflection, and life-long learning to adapt quickly to changing clinical environments and escalating patient care needs. The CNEF will use a… 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 ... in utilization management, behavioral health, and mental health. + Proficiency in clinical and utilization review processes. + Current unrestricted Florida RN… more
- AdventHealth (Daytona Beach, FL)
- …32117 **The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use clinical expertise by analyzing patient records ... algorithmic logic of the XSOLIS Cortex platform, utilizing key clinical data points to assist in status and level...order or a status conflict is indicated, the UM nurse is responsible for escalation to the Physician Advisor… more
- AdventHealth (Orlando, FL)
- …Shift **The role you'll contribute:** Under general supervision of the Director of Clinical Documentation Integrity and in some situations the supervision of the ... Clinical Documentation Integrity Manager, and in collaboration with physicians,...**The value you'll bring to the team:** + Reviews concurrent medical record for documentation compliance including completeness and… more
- AdventHealth (Maitland, FL)
- …+ Three plus of Clinical Documentation Specialist experience + RN - Registered Nurse - State Licensure and/or Compact State Licensure + NPC - Certified Nurse ... year **The role you'll contribute:** Under general supervision of the Director of Clinical Documentation Integrity and in some situations the supervision of the … more
- AdventHealth (Orlando, FL)
- …3 years of Clinical Documentation Specialist experience + RN - Registered Nurse - State Licensure and/or Compact State Licensure Required or + NPC - Certified ... year **The role you'll contribute:** Under general supervision of the Director of Clinical Documentation Integrity and in some situations the supervision of the … more
- BayCare Health System (Tampa, FL)
- …other related parties to ensure appropriate level of care through comprehensive concurrent review for medical necessity of outpatient observation and inpatient ... built on a foundation of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior/RN responsibilities… more
- Centene Corporation (Tallahassee, FL)
- …benefits including a fresh perspective on workplace flexibility. **Position Purpose:** Performs a clinical review and assesses care related to mental health and ... medical appropriateness in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine… more
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