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Reviewer Apply Jobs in Florida (NOW HIRING)

KLDiscovery

Document Reviewer

Doral, FL · On-site

$28/hr

Identify and apply privilege, confidentiality, and responsiveness coding * Conduct quality control ... Electronic document review experience preferred (Nebula, Relativity, responsiveness ...

Genex Services

Utilization Reviewer 2

Tampa, FL · On-site

$59K - $76K/yr

The ideal candidate performs utilization review on workers' compensation related prospective ... Studies have shown that women and underrepresented minorities are less likely to apply to jobs ...

Enlyte

Utilization Reviewer 2

Tampa, FL · On-site

$59K - $76K/yr

Studies have shown that women and underrepresented minorities are less likely to apply to jobs ... Minimum of 2 years of utilization review experience; or an advanced degree without experience.

Enlyte

Utilization Reviewer 2

Tampa, FL · On-site

$59K - $76K/yr

The ideal candidate performs utilization review on workers' compensation related prospective ... Studies have shown that women and underrepresented minorities are less likely to apply to jobs ...

Independent Living Systems

Physician Reviewer

Miami, FL · On-site

Apply established clinical guidelines and criteria to evaluate patient care and support utilization ... Conduct peer-to-peer reviews and reconsiderations with providers requesting a review of denied ...

Tetra Tech

Eligibility Reviewer

Maitland, FL · On-site

$25/hr

Strong attention to detail and the ability to interpret and apply program guidelines consistently ... Excellent organizational skills and ability to manage multiple reviews and deadlines at once.

Tetra Tech

Eligibility Reviewer

Maitland, FL · On-site

$25/hr

Strong attention to detail and the ability to interpret and apply program guidelines consistently ... Excellent organizational skills and ability to manage multiple reviews and deadlines at once.

City of Naples

Building Plan Reviewer

Naples, FL · On-site

$35.60 - $625/hr

Receives and reviews commercial and residential building plans and specifications for compliance ... Requires the ability to apply principles of influence systems, such as motivation, incentive, and ...

Cliftonlarsonallen

Seasonal Tax Reviewer

Orlando, FL · On-site

$103K - $135K/yr

Frequently interface with client personnel to review and apply accounting and tax principles * Contact clients by phone or email to gather necessary information. * Review files to ensure that they ...

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What is the difference between Reviewer Apply vs Content Moderator?

AspectReviewer ApplyContent Moderator
Required CredentialsHigh school diploma or equivalent; training providedHigh school diploma or equivalent; training provided
Work EnvironmentOnline platforms, remote or office-basedOnline platforms, remote or office-based
Industry UsageUsed across e-commerce, social media, and review sitesPrimarily in social media, online forums, and content platforms
Common Search IntentCompare roles, responsibilities, and qualificationsCompare roles, responsibilities, and qualifications

Both Reviewer Apply and Content Moderator roles involve evaluating online content, often requiring similar credentials and work environments. While Reviewer Apply may focus more on assessing reviews or submissions, Content Moderators primarily monitor and manage user-generated content to ensure compliance with platform policies. Understanding these differences helps job seekers identify the right role based on their skills and career goals.

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Nurse Reviewer - Tampa, FL

Healthcare Quality Strategies, Inc.

Tampa, FL • Remote

$40/hr

Part-time

Medical, Dental, Vision, Life, Retirement

Re-posted 14 days ago

Job description

Nurse Reviewer
PT (20-30 hours week) – Remote Work Environment
Non-Exempt: $40.00 hour
Supports Medical Review Services. The Nurse Reviewer plays a critical role in supporting the Medical Review Services department by performing comprehensive medical necessity reviews and policy reviews for Medicaid claims. This involves meticulous examination of claims and medical records to ensure compliance with established guidelines and regulations. The RN will work closely with the Team Lead, Physician Peer Reviewer and contract team. Reviews must be completed timely.
Essential Duties and Responsibilities:
  • Conduct comprehensive medical record reviews to assess medical necessity and compliance with established standards of care and applicable policies
  • Manage end-to-end case screening processes, ensuring all activities are completed within established deadlines
  • Document evidence-based criteria applicable to specific contract requirements
  • Record and report screening results, including relevant referral questions, into a centralized database
  • Evaluate medical claims against industry standards, utilizing research of relevant ICD-10, CPT, and HCPCS codes to determine medical necessity
  • Maintain expert knowledge of evolving multi-state Medicaid policies and vendor expectations
  • Participate in ongoing training and consistently meet or exceed productivity and quality assurance standards
Knowledge, Experience, Skills and Education:
  • Medical terminology, ICD-10, CPT and HCPCS
  • Clinical criteria (InterQual and MCG)
  • Utilization/Medical record review and chart abstraction
  • Current standards of medical practice
  • Comply with HIPAA/HITECH laws and regulations
Experience in:
  • At least three- five years performing medical record review and/or abstraction (Utilization Review experience preferred)
  • Experience performing medical record review, audit for federal or state contracts
  • Knowledge and experience of Medicare and Medicaid policy
  • Proficiency with Microsoft Office (Word, Excel, and Outlook)
  • Proficiency with Adobe PDF files and features
  • Generating accurate, timely, and understandable correspondence
  • Current experience (within the last 3 years) in the application of clinical screening criteria (InterQual and MCG)
Skills Requirements include:
  • Professional interpersonal skills; ability to interact with providers, physicians and peers
  • Solid analytical, assessment and documentation skills
  • Effective written and verbal communication, both internally and externally
  • Strong attention to detail
  • Strong attention to deadlines
  • Organizational skills including effective time management, priority setting and process improvement
  • Ability to work independently and as a member of a team
  • Adapt to changing work situations and readily adjusts schedules, tasks and priorities when necessary to meet business fluctuations
Educational Background:
  • BSN with active RN licensure in good standing
Physical Demands:
Remote Work, Prolonged Sitting, Screen Exposure
This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice.
Healthcare Quality Strategies, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type 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.
This position qualifies for the following Company benefits: Medical/Dental/Vision, FSA and HSA, group life/AD amp;D, voluntary life/AD amp;D, 401k
For immediate consideration, please apply via the HQSI Careers Page at: www.hqsi.org gt; Careers gt; Current Employment Opportunities
EOE: Minorities/Females/Disabled/Veterans
Healthcare Quality Strategies, Inc. is Equal Opportunity, Affirmative Action Employer and an Alcohol/Drug Free Workplace
Healthcare Quality Strategies, Inc. is an E-Verify Employer

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