- 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
- CVS Health (Tallahassee, FL)
- …clinical criteria to evaluate outpatient and inpatient services requiring precertification and concurrent review . + Conduct clinical reviews via phone and ... members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant to join our remote team. **Key Responsibilities**...At least 1 year of Utilization Management experience in concurrent review or prior authorization. + Strong… more
- AdventHealth (Tampa, FL)
- …you'll contribute:** The role of the Emergency Department Utilization Management (UM) Registered Nurse (RN) is to use clinical expertise by analyzing patient ... also located at AdventHealth Tampa, leads the way in clinical and academic research in the areas of neuroscience,...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)
- …and 3 years of Clinical Documentation Specialist experience + RN - Registered Nurse - State Licensure and/or Compact State Licensure + NP - 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
- 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
- AdventHealth (Tampa, FL)
- …inpatients, sending/presenting opportunities for improved documentation compliance to physicians, nurse practitioners and other clinical team members. ... Research Institute, also located at AdventHealth Tampa, leads the way in clinical and academic research in the areas of neuroscience, cardiovascular medicine,… more
- AdventHealth (Altamonte Springs, FL)
- …FL **The role you will contribute:** Under general supervision of the Clinical Documentation Integrity (CDI) Manager, and in some situations the supervision of ... the Director of Clinical Documentation Integrity, and in collaboration with physicians, nursing...Stewardship, and Teamwork + Completes accurate and timely record review to ensure the integrity of clarification compliance for… more
- Molina Healthcare (Orlando, FL)
- …requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial process. + Monitors appropriate care ... national, state, and local laws and regulatory requirements affecting the medical and clinical staff. + Marketplace UM reviews + MD licenses required for the… more
- HCA Healthcare (Tallahassee, FL)
- …and accountability in ensuring all admissions and continued stays meet clinical criteria for appropriateness and medical necessity. Assesses discharge planning needs ... level of care across the continuum. Ensures plan meets patient's clinical , psychological and discharge needs in collaboration with the attending physician… more
- Elevance Health (Miami, FL)
- …+ Requires HS diploma or equivalent, and a minimum of 2 years of clinical experience and/or utilization review experience. + Current active, valid and ... ensuring appropriate, consistent administration of plan benefits by reviewing clinical information and assessing medical necessity under relevant guidelines and/or… more
- HCA Healthcare (Kissimmee, FL)
- …database to ensure adequate documentation as required by regulatory agencies. + Complete concurrent review of cases to identify quality, timelines and systems of ... and Patient Safety (PIPS) Program. The PI Coordinator will review the continuum of care to determine compliance with...trauma patients. + Serve as a liaison to the clinical areas responsible for trauma patients. + Coordinate multidisciplinary… more
- BrightSpring Health Services (Gainesville, FL)
- …for assisting the Director of Nursing with the daily performance of clinical personnel by ensuring proper care is delivered to patients/clients. Serves as ... monitors both skilled and non-skilled healthcare services + Directly supervises clinical personnel + Provides clinical teaching and conducts performance… more
- HCA Healthcare (Miami, FL)
- …At HCA Florida Kendall Hospital, our nurses play a vital part. We know that every nurse 's path and purpose is unique. Do you want to create your own personal career ... and Qualifications** The Burn PI Coordinator performs retrospective and concurrent reviews of patient care records and assesses for...thorough written presentation is developed to facilitate a formal review by BMD, BPD, and Burn M&M Committee when… more