8 clinical review nurse jobs at 3 companies in Ormond Beach, FL
1w
Save
Mark Applied
Hide
Mgr, Clinical Denials Management
Altamonte Springs, Florida, United States
$86k-$159k/yr RemoteFull Time
4+ YOE2+ MgmtRequires a BSN or qualifying clinical experience, ACM or RN credential, and expertise in clinical denials, utilization review, coding, payer policies, analytics, compliance, and team supervision; 2+ years supervisory experience preferred.
Microsoft Suite, Epic EHR, MCG, InterQual, CPT, HCPCS, ICD
6d
Save
Mark Applied
Hide
Clinical Denials Management Specialist
Altamonte Springs, Florida, United States
$71k-$131k/yr RemoteFull Time
3+ YOERequires bachelor's degree, RN license, 3+ years acute clinical RN experience, and 2+ years utilization or appeals experience using InterQual or MCG; strong payer, coding, clinical review, writing, and Microsoft Suite skills.
CPT, HCPCS, ICD, UB-04 Revenue Codes, MCG, InterQual, Electronic Medical Record (EMR), Microsoft Word, Microsoft Excel, Microsoft Outlook, Microsoft Teams
1w
Save
Mark Applied
Hide
Mgr, Clinical Denials Management
Altamonte Springs or United States
$86k-$159k/yr RemoteFull Time
4+ YOE2+ MgmtBachelor's degree in nursing or related healthcare field, ACM or RN required, and experience in supervisory/managerial work, utilization review, care management, revenue integrity, or denial management.
CPT, HCPCS, ICD, MCG, InterQual, Microsoft Suite, Epic EHR
1mo
Save
Mark Applied
Hide
Appeals and Grievances Clinical Specialist/ Quality Of Care
New York City or Lake Mary
$83k-$120k/yr HybridFull Time
Active RN required; experience in clinical practice and appeals & grievances, claims processing, utilization review or case management; knowledge of utilization review guidelines and ability to manage large caseloads.
Microsoft Word, Microsoft Excel, Macess, CCMS, TruCare, Hyland, InterQual, Milliman
1mo
Save
Mark Applied
Hide
Appeals and Grievances Clinical Specialist/ Quality Of Care
New York or New York City or Lake Mary
$73k-$120k/yr RemoteFull Time
Active RN required; experience in appeals & grievances, utilization review, or case management preferred; familiarity with utilization guidelines and ability to manage large caseloads under regulatory timeframes.
Microsoft Word, Microsoft Excel, Macess, CCMS, TruCare, Hyland, InterQual, Milliman
2mo
Save
Mark Applied
Hide
Second Level Reviewer I PRN Remote
Altamonte Springs, Florida, United States
$32-$59/hr RemotePart Time
5+ YOEBSN required (Master's preferred), 5+ years acute care nursing, 3+ years clinical documentation specialist experience, RN/PA/APRN or CCDS required, strong clinical documentation, coding knowledge, communication and computer skills.
CDI Software
1mo
Save
Mark Applied
Hide
MDS Coordinator
Daytona Beach, Florida, United States
$70k-$82k/yr OnsiteFull Time
2+ YOEActive RN or LPN license in state, proficiency in MDS 3.0, 2+ years LTC clinical experience, knowledge of federal/state regulations, utilization review and care planning skills.
MDS 3.0
1mo
Save
Mark Applied
Hide
Second Level Reviewer I PRN Remote
Altamonte Springs, Florida, United States
$32-$59/hr RemotePart Time
5+ YOERequires RN/PA/APRN or CCDS credential, BSN (or equivalent), 5+ years acute care nursing, 3+ years clinical documentation specialist experience, strong clinical knowledge, communication, and computer skills.