Top 20 Clinical reviewer Jobs in Tampa Fl

Inpatient DRG Reviewer
Zelis —Florida
- $79,000 - $99,750 a year
- Full-time
- LVN
- RN License
- Mid-level
- Paid holidays
- Disability insurance
Licensed Psychologist, Peer Reviewer - Remote in Florida
UnitedHealth Group —Tampa, FL
- $91,700 - $163,700 a year
- Full-time
- Remote
- Microsoft Excel
- Microsoft Access
- Microsoft Outlook
Utilization Management Rep I (contract)
Elevance Health —Tampa, FL
- Call employer
- Hybrid work
- High school diploma or GED
- US work authorization
- Data entry
- Health savings account
- Disability insurance
Oncology Data Specialist PRN
AdventHealth Tampa —Tampa, FL
- $23.71 - $44.09 an hour
- PRN
- Background check
- Hospital
- Mid-level
- Paid parental leave
- Disability insurance
MemoryWorkx Intake Coordinator
Sage Infusion —Tampa, FL
- Full-time
- Background check
- Spanish
- Computer literacy
Quick Apply
1d
Certified Oncology Data Specialist Part Time
AdventHealth Tampa —Tampa, FL
- $23.71 - $44.09 an hour
- Part-time
- Background check
- Hospital
- Mid-level
- Paid parental leave
- Disability insurance
2d
Clinical Quality Assurance Reviewer Adult
Directions for Living —Clearwater, FL
- $87,500 a year
- Full-time
- LMFT
- Licensed Clinical Social Worker
- Adults
- Paid holidays
- Disability insurance
Quick Apply
Utilization Reviewer 2
Enlyte —Tampa, FL
- $59,500 - $76,000 a year
- Full-time
- RN License
- Mid-level
- Office
- Health savings account
- AD&D insurance
Intake Coordinator
Banyan Treatment Centers —Seminole, FL
- Full-time
- CPR Certification
- BLS Certification
- Mid-level
- Wellness program
- Paid holidays
Quick Apply
UM Authorization Analyst 2 Bilingual
Starling Oncology —Tampa, FL
- $71,000 - $85,000 a year
- Remote
- Spanish
- Customer service
- English
Quick Apply
5d
Clinical Nurse Reviewer
Zelis —Saint Petersburg, FL
- $59,000 - $75,050 a year
- Full-time
- Nursing
- RN License
- Inventory management
- Paid holidays
- Disability insurance
Chiropractor
Dane Street, LLC —Tampa, FL
- Contract
- Mid-level
- Analysis skills
- Communication skills
Quick Apply
(Part-Time) Legal Nurse Case Reviewer | Orthopaedics / Neurosurgery | Onsite
Shimspine —Oldsmar, FL
- Part-time
- Nursing
- RN License
- 5 years
- Paid training
- Flexible schedule
Quick Apply
Psychologist Reviewer
BHM Healthcare Solutions —Tampa, FL
- $38 - $48 an hour
- Full-time
- Hybrid work
- Background check
- Writing skills
- Office
- Health insurance
- Dental insurance
Quick Apply
10d
VP, Market Medical Director
Greenbrook Medical —Tampa, FL
- Hybrid work
- Medicine
- 5 years
- System design
- Dental insurance
- Paid time off
VP, Market Medical Director
TGH Senior Center Powered by Greenbrook Medical —Tampa, FL
- Hybrid work
- Medicine
- 5 years
- System design
- Dental insurance
- Paid time off
Licensed Psychologist, Peer Reviewer - Remote in Florida
Optum —Tampa, FL
- $91,700 - $163,700 a year
- Full-time
- Remote
- Microsoft Excel
- Microsoft Access
- Microsoft Outlook
Quick Apply

Discover related jobs

Based on your search for clinical reviewer jobs.

MemoryWorkx Intake Coordinator
Sage Infusion —Tampa, FL
This role may eventually develop into Benefits Investigation and Cost Estimate Training as related to MemoryWorkx patients.
Quick Apply
1d
RN Care Manager, Acute
Orlando Health —Lakeland, FL
Free NCPDs for RN license. Must hold and maintain a current Florida RN license. Monitors and evaluates data, fiscal outcomes, and other relevant information to…
4d

Show more related jobs

Explore jobs in cities nearby

Check out jobs in cities near your current location, Columbus

Clinical Reviewer - Medical Coder & QA
Ohio Living —Westerville, OH
Current unencumbered license for the state of Ohio to practice as a Licenses Practical Nurse (LPN) preferred Certificate for OASIS Specialist-Clinical…
Quick Apply
Senior Quality Assurance Specialist - Investigations
Andelyn Biosciences, Inc —Columbus, OH
Bachelor’s Degree in a technical or scientific discipline or equivalent • Operational knowledge of cGMP regulations and guidelines including but not limited to…
Quick Apply
3d

Show more jobs in cities nearby

I want to receive the latest job alert for clinical reviewer in tampa fl

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

clinical reviewer jobs near tampa fl

Inpatient DRG Reviewer

Zelis -
Florida

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 experience
Medicare
LVN
RN License
Audit report preparation
Medical software
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
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.

At Zelis, AI is woven into the fabric of how we work. Every associate is expected - and empowered - to partner with AI to challenge the status quo, accelerate innovation, and amplify their impact. This is a place for builders with a growth mindset who act with agility, embrace change, and use modern technology to shape smarter solutions, exceptional experiences, and the future of our industry for our clients, customers, and our culture.

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

Zelis is headquartered in the U.S., with multiple locations across the country and in Hyderabad, India. Check out our locations to learn more about our offices. All employee work locations are based on the needs of the position and are determined by the Leadership team. In-office work and activities vary based on work and team objectives in accordance with Company policies.

While location expectations vary by role, candidates within approximately 50 miles of a U.S. office are generally preferred to support collaboration when needed. Our hybrid approach is flexible, and in-office presence is guided by team and business needs rather than a fixed weekly schedule.

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

clinical reviewer jobs in tampa fl

Inpatient DRG Reviewer

Licensed Psychologist, Peer Reviewer - Remote in Florida

Utilization Management Rep I (contract)

Oncology Data Specialist PRN

MemoryWorkx Intake Coordinator

Certified Oncology Data Specialist Part Time

Clinical Quality Assurance Reviewer Adult

Utilization Reviewer 2

Intake Coordinator

UM Authorization Analyst 2 Bilingual

Clinical Nurse Reviewer

Chiropractor

(Part-Time) Legal Nurse Case Reviewer | Orthopaedics / Neurosurgery | Onsite

Psychologist Reviewer

VP, Market Medical Director

VP, Market Medical Director

Licensed Psychologist, Peer Reviewer - Remote in Florida

Discover related jobs

Explore jobs in cities nearby

I want to receive the latest job alert for clinical reviewer in tampa fl

Explore jobs in more locations

Description

Job Seeker Tools

Employer Tools

Browse

Stay Connected