Top 339 remote rn quality Jobs in florida

Inpatient DRG Reviewer
Zelis —Saint Petersburg, FL
- $79,000 - $99,750 a year
- Full-time
- Hybrid work
- LVN
- RN License
- Mid-level
- Paid holidays
- Disability insurance
RN Compliance Specialist
St. Francis Hospice —Titusville, FL
- Full-time
- Nursing
- RN License
- Mid-level
- Health savings account
- Health insurance
Quick Apply
5d
Nursing Supervisor, Hospice
AccentCare, Inc. —Tampa, FL
- $92,000 - $105,000 a year
- Full-time
- CPR Certification
- Nursing
- Surgery
- Health savings account
- Paid holidays
Quick Apply
DIRECTOR OF CLINICAL RISK MANAGEMENT AND QUALITY ASSURANCE
Confidential —Spring Hill, FL
- $87,289.60 - $105,122.96 a year
- Full-time
- Background check
- Management
- RN License
- Health insurance
- Dental insurance
Quick Apply
10d
Start of Care (SOC) Nurse
Home Heart —Lakeland, FL
- $125 - $375 a day
- Part-time
- Hybrid work
- RN License
- BLS Certification
- Mid-level
- Flexible schedule
Quick Apply
3d
RN Quality Pediatric Cardiac ICU/Transplant Specialist - FT - Days - JDCH
Memorial Healthcare System —Hollywood, FL
- Online Application
- Nursing
- Medicine
- RN License
RN Runner Nights $6,000 Bonus
St. Francis Hospice —Brevard County, FL
- Full-time
- Nursing
- RN License
- Driver's License
- Health savings account
- Health insurance
Quick Apply
5d
Area Director Clinical Operations (Hybrid-Remote from West Palm area)
Florida Cancer Specialists & Research Institute —West Palm Beach, FL
- Full-time
- Hybrid work
- Background check
- Nursing
- 7 years
- Tuition reimbursement
- 401(k) matching
CDI Specialist
HCTec —Florida
- Up to $95,000 a year
- Full-time
- Remote
- Nursing
- RN License
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
4d
Nurse Supervisor Medical Surgical Full-Time Nights
Clinical Management Consultants —Hialeah, FL
- $95,950 - $125,650 a year
- Full-time
- Acute care
- Nursing
- Patient monitoring
- Health insurance
- Dental insurance
Clinical Risk & Safety Manager
United Vein & Vascular Centers —Tampa, FL
- Nursing
- RN License
- BLS Certification
Quick Apply
5d
Start of Care (SOC) Nurse
Home Heart —Tampa, FL
- $125 - $375 a day
- Part-time
- Hybrid work
- RN License
- BLS Certification
- Mid-level
- Flexible schedule
Quick Apply
3d
NEEDED HHA, CNA, LPN, RN
Quality Homecare Professionals LLC —Orlando, FL
- $13 - $15 an hour
- Part-time
- Background check
- Spanish
- RN License
- COVID-19 protective measures
Quick Apply
Utilization Management Registered Nurse
Humana —Florida
- $71,100 - $97,800 a year
- Full-time
- Remote
- Nursing
- RN License
- Mid-level
- Paid parental leave
- Paid holidays
Medical Review Nurse - Home Health Auditor
Performant Financial Corporation —Plantation, FL
- $78,500 - $90,000 a year
- Full-time
- Remote
- RN License
- Computer literacy
- Writing skills
- Health savings account
- Paid holidays
UM BH Registered Nurse
Humana —Florida
- Part-time
- Remote
- Nursing
- RN License
- Military
- Work from home
Care Review Clinician (RN) - Remote in FL
Molina Healthcare —Florida
- $26.41 - $51.49 an hour
- Full-time
- Remote
- RN License
- Mid-level
- Critical & Intensive Care
- Health insurance
Clinical Investigator I (Special Investigation Unit)
Centene —Florida
- $56,200 - $101,000 a year
- Full-time
- Remote
- RN License
- Medical office experience
- Licensed Clinical Social Worker
- Paid holidays
- Health insurance
RN Telephone Triage (Work from Home)
TeamHealth —Tampa, FL
- Weekends as needed
- Remote
- Spanish
- RN License
- HIPAA
- Paid training
- Work from home
10d
RN Telehealth
Total Life, Inc. —Florida
- Full-time
- Remote
- Spanish
- Nursing
- Psychiatry
Quick Apply

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Inpatient DRG Reviewer

Zelis -
Saint Petersburg, FL

Apply Now

Job Details

Full-time
$79,000 - $99,750 a year

Benefits

Paid holidays
Disability insurance
Health insurance
Dental insurance
Paid time off
Vision insurance
401(k) matching
Prescription drug insurance

Qualifications

Defect resolution root cause analysis
Inpatient
Medicare
LVN
RN License
Audit report preparation
Process optimization
Health insurance policy knowledge
Process improvement
Healthcare documentation compliance audits
Medical billing compliance checks
Mid-level
Audit Reporting
Evidence-based practice
Retrospective medical coding audits
Medicare regulations
Document review
Organizational skills
Root cause analysis
Insurance claims auditing
Clinical documentation standards
Healthcare claims compliance audits
Standard operating procedures (SOPs)
Communication skills
DRG

Full Job Description

Description

At Zelis, we Get Stuff Done. So, let’s get to it!

A Little About Us

Zelis is modernizing the healthcare financial experience across payers, providers, and healthcare consumers. We serve more than 750 payers, including the top five national health plans, regional health plans, TPAs and millions of healthcare providers and consumers across our platform of solutions. Zelis sees across the system to identify, optimize, and solve problems holistically with technology built by healthcare experts – driving real, measurable results for clients.

A Little About You

You bring a unique blend of personality and professional expertise to your work, inspiring others with your passion and dedication. Your career is a testament to your diverse experiences, community involvement, and the valuable lessons you've learned along the way. You are more than just your resume; you are a reflection of your achievements, the knowledge you've gained, and the personal interests that shape who you are.

Position Overview

As part of the Price Optimization division, this role is responsible for conducting post-service, pre-payment and post pay comprehensive inpatient DRG reviews based on industry standard inpatient coding guidelines and rules, evidence based clinical criteria plan, and policy exclusions. Conduct reviews on inpatient DRG claims as they compare with medical records ICD-10 Official Coding Guidelines, AHA Coding Clinic and client specific coverage policies. Conduct prompt claim review to support internal inventory management to achieve greatest savings for clients.

What you will do:

Perform comprehensive inpatient DRG validation reviews to determine accuracy of the DRG billed, based on industry standard coding guidelines and the clinical evidence supplied by the provider in the form of medical records such as physician notes, lab tests, images (x-rays etc.), and with due consideration to any applicable medical policies, medical best practice, etc.
Perform readmission reviews, including evaluating prior and current admissions to determine preventability, relatedness, and compliance with readmission policies.
Based on the evidence presented in the medical records, determine, and record the appropriate (revised) Diagnosis Codes, Procedure Codes and Discharge Status Code applicable to the claim.
Using the revised codes, regroup the claim using provided software to determine the ‘new DRG’
Where the regrouped ‘new DRG’ differs from what was originally claimed by the provider, write a customer facing ‘rationale’ or ‘findings’ statement, highlighting the problems found and justifying the revised choices of new codes and DRG, based on the clinical evidence obtained during the review
Document all aspects of audits including uploading all provider communications, clinical rationale, and/or financial research
Identify new DRG coding concepts to expand the DRG product.
Manage assigned claims and claim report, adhering to client turnaround time, and department Standard Operating Procedures
Meet and/or exceed all internal and department productivity and quality standards
Recommend new methods to improve departmental procedures
Achieve and maintain personal production and savings quota
Maintain awareness of and ensure adherence to Zelis standards regarding privacy

What you will bring:

RN or LVN required
Inpatient Coding Certification required (CCS, CIC) within 4 – 6 months of hire date
1 -3 years reviewing and or auditing ICD-10 CM, MS-DRG and APPR-DRG claims preferred
Experience and working knowledge of Health Insurance, Medicare guidelines and various healthcare programs
Experience performing readmission reviews, including evaluating relatedness, preventability, and compliance with readmission policies
Understanding of hospital coding and billing rules
Clinical skills to evaluate appropriate Medical Record Coding
Experience conducting root cause analysis and identifying solutions
Strong organization skills with attention to detail
Outstanding verbal and written communication skills

Please note at this time we are unable to proceed with candidates who require visa sponsorship now or in the future.

Location and Workplace Flexibility

We have offices in Atlanta GA, Boston MA, Morristown NJ, Plano TX, St. Louis MO, St. Petersburg FL, and Hyderabad, India. We foster a hybrid and remote friendly culture, and all our employee's work locations are based on the needs of the position and determined by the Leadership team. In-office work and activities, if applicable, vary based on the work and team objectives in accordance with Company policies.

Base Salary Range

$79,000.00 - $99,750.00

At Zelis we are committed to providing fair and equitable compensation packages. The base salary range allows us to make an offer that considers multiple individualized factors, including experience, education, qualifications, as well as job-related and industry-related knowledge and skills, etc. Base pay is just one part of our Total Rewards package, which may also include discretionary bonus plans, commissions, or other incentives depending on the role.

Zelis’ full-time associates are eligible for a highly competitive benefits package as well, which demonstrates our commitment to our employees’ health, well-being, and financial protection. The US-based benefits include a 401k plan with employer match, flexible paid time off, holidays, parental leaves, life and disability insurance, and health benefits including medical, dental, vision, and prescription drug coverage.

Equal Employment Opportunity
Zelis is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

We welcome applicants from all backgrounds and encourage you to apply even if you don’t meet 100% of the qualifications for the role. We believe in the value of diverse perspectives and experiences and are committed to building an inclusive workplace for all.

Accessibility Support
We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability or a disabled veteran and require a reasonable accommodation with any part of the application and/or interview process, please email [email protected].

Disclaimer

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified. All personnel may be required to perform duties outside of their normal responsibilities, duties, and skills from time to time.

Apply Now

Refine Your Search

remote rn quality jobs in florida

Inpatient DRG Reviewer

RN Compliance Specialist

Nursing Supervisor, Hospice

DIRECTOR OF CLINICAL RISK MANAGEMENT AND QUALITY ASSURANCE

Start of Care (SOC) Nurse

RN Quality Pediatric Cardiac ICU/Transplant Specialist - FT - Days - JDCH

RN Runner Nights $6,000 Bonus

Area Director Clinical Operations (Hybrid-Remote from West Palm area)

CDI Specialist

Nurse Supervisor Medical Surgical Full-Time Nights

Clinical Risk & Safety Manager

Start of Care (SOC) Nurse

NEEDED HHA, CNA, LPN, RN

Utilization Management Registered Nurse

Medical Review Nurse - Home Health Auditor

UM BH Registered Nurse

Care Review Clinician (RN) - Remote in FL

Clinical Investigator I (Special Investigation Unit)

RN Telephone Triage (Work from Home)

RN Telehealth

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