- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- Position Purpose: The Clinical Reviewer serves as a subject matter expert in the clinical review of claims, claim disputes, appeals and FWA special ... investigations Responsibilities: + Review of facility claim disputes including clinical ...Qualifications: + Minimum 5-7 years of experience as a clinical reviewer of facility claims in a… more
- Evolent (Tallahassee, FL)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Clinical Reviewer , Nurse, you will be a key member of the utilization management ... while providing better health outcomes. **Collaboration Opportunities:** As a Clinical Reviewer , Nurse, you will routinely interact...**What You Will Be Doing:** + Functions in a clinical review capacity to evaluate all cases,… more
- Centers Plan for Healthy Living (Margate, FL)
- …applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works within a multidisciplinary team to help ... in their home to improve their quality of life. Utilization Management Clinical Reviewer will assess and process all authorization requests to determine medical… more
- Evolent (Tallahassee, FL)
- …missing or additional documentation from providers per guidelines. + Utilizing clinical guidelines approved by the Utilization Management Committee (UMC), the URN ... or procedures. If a request does not meet established clinical guidelines for appropriateness and medical necessity, the request...medical necessity, the request is sent to a physician reviewer . At no time can a URN recommend an… more
- St. George Tanaq Corporation (Tallahassee, FL)
- …and Skills** + One (1) year of Medicare appeals, medical review , clinical , healthcare regulatory interpretation/application, healthcare compliance or related ... Dispute Resolution Reviewer I Fully Remote*GA Job Type Full-time Description...or related discipline Additional experience in Medicare appeals, medical review , clinical , or other related experience in… more
- AdventHealth (Altamonte Springs, FL)
- …**The role you will 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,...with physicians, nursing and HIM coders, the Second Level Reviewer I strategically facilitates and obtains appropriate and quality… more
- AdventHealth (Maitland, FL)
- …year **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,...with physicians, nursing and HIM coders, the Second Level Reviewer I strategically facilitates and obtains appropriate and quality… more
- HCA Healthcare (Jacksonville, FL)
- …want to join an organization that invests in you as a Coding Quality Audit Reviewer ? At Parallon, you come first. HCA Healthcare has committed up to $300 million in ... We are looking for a dedicated Coding Quality Audit Reviewer like you to be a part of our...result in appropriate reimbursement and data integrity. You will review outcomes are communicated to the HSC team to… more
- St. George Tanaq Corporation (Tallahassee, FL)
- …+ Must have 2-3 years of medical dispute resolution or Medicare appeals, medical review , clinical , or related experience in a healthcare setting + Must have ... Dispute Resolution Reviewer III Fully Remote*GA Job Type Full-time Description...and impartial and supports the determination made, and documents review + Makes sound, independent decisions based on medical… more
- ChenMed (Miami, FL)
- …to join our team. The Physician Reviewer is the primary physician reviewer for Utilization Management/ Clinical Appropriateness review cases in our ... Delegated Utilization Management. **ESSENTIAL JOB DUTIES/RESPONSIBILITIES:** + Provides Delegated Clinical Appropriateness Reviews by covering the specified territories as… more
- Centene Corporation (Tallahassee, FL)
- …an RN or LPN license in the candidate's state. **Position Purpose:** Perform clinical /coding medical claim review to ensure compliance with coding practices ... changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene...through a comprehensive review and analysis of medical claims, medical records, claims… more
- Centene Corporation (Tallahassee, FL)
- …the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, ... monitor care for behavioral health and substance abuse problems according to clinical information given by providers and internal criteria for medical necessity and… more
- Actalent (Tampa, FL)
- …hiring a Clinical Review Nurse role! Job Description The Clinical Reviewer is a telephonic position responsible for recommending discharge plans, ... care guidelines and collaboration with key facility personnel. + Use clinical expertise to review clinical information and criteria to determine if the… more
- BAYADA Home Health Care (Orlando, FL)
- …company match, direct deposit, and employee assistance program **Responsibilities:** + Review clinical information for appropriateness, congruency, and accuracy ... immediate opening for a **Full Time,** OASIS and Coding Review Manager with OASIS and Coding certification to work...for this role (Please note, while this is a clinical opening, BAYADA does have non- clinical openings… more
- BAYADA Home Health Care (Orlando, FL)
- …about BAYADA Benefits, click here (https://www.bayada.com/benefits/) . **Responsibilities:** + Review clinical information for appropriateness, congruency, and ... Home Health Care is hiring a full time OASIS Review and Coding Manager. The OASIS and Coding ...and meeting business and development goals. This is a **non- clinical ** role (Note: Clinical opportunities are also… more
- Actalent (Sunrise, FL)
- …team. In this role, you'll collaborate with an interdisciplinary team to review and authorize behavioral health and substance use services, ensuring appropriate care ... in crisis, including triage, discharge planning, and aftercare referrals. + Review treatment plans and collaborate with Medical Directors on medical necessity.… more
- University of Florida (Sumter County, FL)
- …projects. + Act as a resource for research staff in the implementation of clinical research protocols and review of study goals and outcomes, providing guidance ... participant recruitment, including human-subject protection, health studies and Institutional Review Boards SKILLS + Clinical -trials management systems and… more
- Bausch + Lomb (Tallahassee, FL)
- …+ Provide Clinical Operations support in the timely coordination and execution of clinical study reports. + Assist in the review of regulatory reports to ... Summary** **:** Is responsible for the implementation and oversight of clinical study operations by organizing and coordinating with other relevant parties… more
- HCA Healthcare (Sunrise, FL)
- …in other clinical value analysis or service line committees to review products and technology for clinical evidence and benefit; discuss financial ... we encourage you to apply for our Vice President Clinical Operations opening. We promptly review all...Vice President Clinical Operations opening. We promptly review all applications. Highly qualified candidates will be contacted… more
- AdventHealth (Altamonte Springs, FL)
- …retrospective review process, oversight of provider communication, provider and clinical documentation specialist education, oversight of the Quality and Safety ... **The role you will contribute:** The Corporate Director of Clinical Documentation Integrity (CDI) is responsible for developing and...Review Process and guidance for recommended CDI staffing. The… more