- Actalent (Miami, FL)
- Urgent Hiring for " Remote Clinical Review Nurses" Job Description: + Review approximately 20 cases a day for medical necessity. + Advocate for and ... complete cases. Qualifications: + 3+ years of utilization management, concurrent review , prior authorization, utilization review , case management, and discharge… more
- Molina Healthcare (Miami, FL)
- JOB DESCRIPTION **Job Summary** The RN Clinical Appeals Nurse provides support for internal appeals clinical processes - ensuring that appeals requests are ... Validation is a plus. Work hours: Monday - Friday 8:00am- 5:00pm Remote position **Essential Job Duties** * Performs clinical /medical reviews of previously… more
- Evolent (Tallahassee, FL)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior ... policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as...Oncology, ICU, ED, or other critical care environment + Remote work experience To ensure a secure hiring process… more
- AccentCare, Inc. (Miami, FL)
- Overview Clinical Manager Inpatient Hospice Center, Registered Nurse Location: North Shore Hospital, Miami, FL Position Type: Full-Time Remote /Virtual ... Position: No Find Your Passion and Purpose as a Clinical Manager Inpatient Hospice Center, Registered Nurse ...required time frames. + Coordinate the development, implementation and review of the interdisciplinary plan of care for each… more
- CVS Health (Tallahassee, FL)
- …do it all with heart, each and every day. **Position Summary** **This is a remote work from home role anywhere in the US with virtual training.** American Health ... clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures and regulatory… more
- Datavant (Tallahassee, FL)
- …realize our bold vision for healthcare. **What We're Looking For:** As a Clinical Documentation Quality Improvement (CDQI) Specialist, you will play a pivotal role ... Collaborate with physicians and caregivers to ensure appropriate reimbursement and clinical severity for DRG-based payer patients. + Demonstrate understanding of… more
- Molina Healthcare (Jacksonville, FL)
- …that goals are achieved. + Manages and evaluates performance of various clinical outreach management activities. + Aligns with leadership, to ensure operational ... as process champion of initiatives. + Develops executive presentations as needed for review of vendor performance. + Engages in training activities and outcomes. +… more
- Humana (Tallahassee, FL)
- …a part of our caring community and help us put health first** The Nurse Auditor 2 performs clinical audit/validation processes to ensure that medical record ... complete, compliant and accurate to support optimal reimbursement. The Nurse Auditor 2 work assignments are varied and frequently... clinical and coding experience to conduct a clinical validation review of the inpatient medical… more
- Battelle Memorial Institute (Eglin AFB, FL)
- …Research and Analytics (HRA) business line is seeking a highly motivated, full-time ** Nurse Case Manager** to join our team in support of our government customer, ... and their families, ensuring comprehensive support for those who serve. As a Nurse Case Manager, you will contribute to impactful research and analytics that drive… more
- CenterWell (Tallahassee, FL)
- …When working weekends, it will allow for off-days during the week.** The ** Clinical Care Coordinator/Care Manager, Telephonic Nurse ** helps to ensure optimal ... regarding Home Health, Hospice, and Palliative Care Services. + Assist with clinical eligibility review for alternate services + Participates in special… more