Current jobs related to RN Case Mgr/Doc Specialist - Ocoee - Orlando Health
-
RN Case Mgr/Doc Specialist
6 days ago
Ocoee, United States Health Central Hospital Full timeRN Case Mgr/Doc SpecialistPosition Summary Promotes and facilitates effective use of outpatient hospital and clinic resources. Responsibilities Essential Functions Assists with developing comprehensive case management plan addressing patient/family needs. Audits documentation and denied claims, ensures compliance with documentation requirements, and...
-
RN Case Mgr/Doc Specialist
7 days ago
Ocoee, FL, United States Health Central Hospital Full timeRN Case Mgr/Doc SpecialistPosition Summary Promotes and facilitates effective use of outpatient hospital and clinic resources. Responsibilities Essential Functions Assists with developing comprehensive case management plan addressing patient/family needs. Audits documentation and denied claims, ensures compliance with documentation requirements, and...
-
Ocoee, Florida, United States Health Central Hospital Full timeJob SummaryThis role is designed for a skilled RN to facilitate effective use of outpatient hospital and clinic resources, ensuring quality patient care and medical necessity criteria are met. The RN will work closely with patients, families, physicians, nurses, and other departments to develop comprehensive case management plans, audit documentation, and...
-
Home Care Nurse Specialist
1 month ago
Ocoee, Florida, United States AdventHealth Full timeAdventHealth is a faith-based and mission-driven agency that offers a unique opportunity for Licensed Practical Nurses to provide one-on-one patient care in the comfort of their own homes.The salary for this position is estimated to be around $68,000-$80,000 per year, depending on experience and location. As a Home Care Nurse Specialist, you will be...
-
Certified Anesthesiology Specialist
2 weeks ago
Ocoee, Florida, United States Envision Physician Services - ANES Full timeCertified Anesthesiology Specialist OpportunityEnvision Physician Services has exciting new opportunities for a full-time Certified Anesthesiology Specialist with our Orlando Health division.We are seeking a highly skilled and dedicated professional to join our team. As a member of this well-respected practice, you will benefit from a diverse mix of cases...
-
Wound Care Physician Specialist
4 weeks ago
Ocoee, Florida, United States Korzen Health Full timeKorzen Health is a leading healthcare organization seeking an experienced Wound Care Physician Specialist to lead its outpatient Wound Care Clinic in Orlando. This 4 days/week position offers a unique opportunity for medical professionals to specialize in wound care and hyperbaric oxygen therapy.We provide comprehensive training programs in Wound Care and...
-
Advanced Patient Care Specialist
1 month ago
Ocoee, Florida, United States Orlando Health Full timeAt Orlando Health, we are seeking a skilled Advanced Patient Care Specialist to join our team. In this rewarding role, you will be responsible for delivering exceptional patient care in an acute care setting.About the RoleAs an Advanced Patient Care Specialist, you will have the opportunity to make a meaningful impact on patients' lives by providing...
-
Palliative Care Nurse Specialist
2 weeks ago
Ocoee, Florida, United States Chapters Health System Full time**Job Title:** Palliative Care Nurse Specialist**Estimated Salary:** $70,000 - $110,000 per yearAs a Palliative Care Nurse Specialist at Chapters Health System, you will have the opportunity to work with a diverse population of patients and families, providing expert care and support in a variety of settings.**Responsibilities:Assess and identify...
-
Clinical Nurse Specialist
4 weeks ago
Ocoee, Florida, United States Health Central Hospital Full timeJob SummaryWe are seeking a skilled registered nurse to join our team at Health Central Hospital. As a clinical nurse specialist, you will be responsible for providing high-quality patient care and leading by example in our hospital's commitment to excellence.About the RoleThe clinical nurse specialist will work closely with our interdisciplinary team to...
-
Orthopedic Nurse Specialist
2 weeks ago
Ocoee, Florida, United States Health Central Hospital Full timeAt Health Central Hospital, we are committed to providing our patients with the highest level of care in a compassionate and supportive environment.Job SummaryWe are seeking an experienced Orthopedic Nurse Specialist to join our team. The successful candidate will have excellent clinical skills, strong communication abilities, and a passion for delivering...
-
Nurse Specialist
2 weeks ago
Ocoee, Florida, United States Health Central Hospital Full timeHealth Central Hospital is seeking a skilled Nurse Specialist to join our Progressive Care Unit team in Orlando, Florida.Job SummaryAs a Nurse Specialist, you will be responsible for providing high-quality patient care in an acute setting. You will assess patients' needs, develop individualized care plans, and collaborate with medical staff to effectively...
-
Clinical Nurse Specialist
4 weeks ago
Ocoee, Florida, United States Health Central Hospital Full timeAt Health Central Hospital, we are dedicated to providing exceptional patient care and a supportive work environment for our nursing staff.About the RoleWe are seeking an experienced Registered Nurse to join our Orthopedic Spine Unit as a Clinical Nurse Specialist. In this role, you will have the opportunity to work with a talented team of healthcare...
-
Nurse Specialist
1 month ago
Ocoee, Florida, United States Orlando Health Full timeAbout Orlando HealthOrlando Health is a comprehensive medical and surgical acute-care facility with over 70 years of serving the residents of west Orange County, Florida.Job SummaryWe are seeking a skilled Nurse Specialist - Patient Care to join our team. This role will involve administering patient care in a hospital setting, ensuring active treatment for...
-
Nurse Care Specialist
2 weeks ago
Ocoee, Florida, United States EVEREST REHABILITATION HOSPITALS Full timeJob Title: Nurse Care SpecialistWe are seeking a highly skilled Nurse Care Specialist to join our team at Everest Rehabilitation Hospitals. As a key member of our healthcare team, you will provide expert nursing care and support our patients and their families through every stage of the rehabilitation process.Job Summary: The successful candidate will be...
-
Critical Care Nurse Specialist
4 weeks ago
Ocoee, Florida, United States Health Central Hospital Full timeJob OverviewAs a Critical Care Nurse Specialist at Health Central Hospital, you will play a vital role in delivering exceptional patient care in our intensive care unit. With a focus on providing compassionate and personalized care, you will work closely with our multidisciplinary team to ensure the best possible outcomes for our patients.About UsHealth...
-
Cloud-Based Sales Specialist
4 weeks ago
Ocoee, Florida, United States iCoreConnect Full timeAbout the Role:">We are seeking a results-driven Inside Sales Representative to join our team in Ocoee, Florida. As an Inside Sales Rep, you will be responsible for identifying viable leads, qualifying prospects, and acquiring new business to meet and exceed established revenue goals. About You: ">">You have successful sales experience hitting and exceeding...
-
Critical Care Nurse Specialist
3 weeks ago
Ocoee, Florida, United States Chapters Health System Full timeAbout the RoleAs a Critical Care Nurse Specialist with Chapters Health System, you will play a vital role in providing exceptional patient care and support to individuals and their families at our Hospice House. This is a per-diem opportunity for experienced Registered Nurses (RNs) who are passionate about delivering compassionate and expert care.Job...
-
Critical Care Nurse Specialist
2 weeks ago
Ocoee, Florida, United States Health Central Hospital Full timeJob Summary: We are seeking a skilled and compassionate Critical Care Nurse Specialist to join our team at Health Central Hospital. As a key member of our healthcare team, you will be responsible for providing high-quality patient care in a fast-paced and dynamic environment.About Us: Orlando Health - Health Central Hospital is a comprehensive medical and...
-
Clinical Care Specialist
4 weeks ago
Ocoee, Florida, United States Chapters Health System Full time**Job Overview:**We are seeking a highly skilled and compassionate Clinical Care Specialist to join our team at Chapters Health System. As an essential member of our healthcare team, you will provide exceptional care and support to patients in their homes, ensuring they receive the highest quality treatment and attention.The ideal candidate for this role is...
-
Nursing Professional
2 weeks ago
Ocoee, Florida, United States Orlando Health Full timeCompany OverviewOrlando Health is a comprehensive medical and surgical acute-care facility that has been serving the residents of west Orange County for over 70 years. Our hospital has earned accreditations and designations in various specialty services, including bariatric, spine, stroke, hip replacement, and knee replacement.We are committed to providing...
RN Case Mgr/Doc Specialist
2 months ago
Position Summary
Promotes and facilitates effective use of outpatient hospital and clinic resources.
Responsibilities
Essential Functions
• Assists with developing comprehensive case management plan addressing patient/family needs.
• Audits documentation and denied claims, ensures compliance with documentation requirements, and assists in resolving
medical necessity pre- and post-payment issues.
• Interacts with patients and family members, physicians, nurses, and other physician office staff, business office, pharmacy,
insurance companies, and other departments to facilitate delivery of quality patient care ensuring medical necessity criteria are
met.
• Audits accounts when preauthorization has been denied for outpatient services and determines process for appeal, etc.
Facilitates physician-to-physician case reviews as needed.
• Collaborates with representatives from PFS/appeals department to appropriately facilitate all appeals with Administrative Law
Judge.
• Conducts audits of orders written to ensure medical necessity criteria are met. Reviews claim denials and collaborates with
physicians to establish medical necessity. Reviews denials of off label treatments in compliance with review requirements for
Managed Care contracts, governmental payers (i.e. Medicare, Medicaid, and Champus), and departmental review policies.
Collaborates with physicians regarding medical necessity criteria and determination of pursuit of appeal.
• Develops collaborative relationships with patients/families, patient business, nursing staff/leadership, physicians, social
workers, and ancillary services to facilitate optimum outcomes of outpatient case management activities.
• Collaborates with coding, PFS, revenue integrity and appeals departments to ensure medical necessity criteria are met for
billable charges. Conducts medical review of charges for coding and billing accuracy and medical appropriateness in support of
payment policies of organization and individual payers.
• Conducts audit of pre-billed claims within database for medical necessity and provides additional required information to
support billable charge. Identifies inappropriate charges and works with billing/revenue integrity departments to identify root
cause. Works closely with charge analysts as a medical resource.
• Performs retroactive medical records review to determine medical necessity of services.
• Identifies trends within the outpatient departments and provides staff education for performance improvement.
• Participates in outpatient staff meetings, revenue committee meetings, case management staff meetings, and task force
working to facilitate Sunrise into the outpatient practice areas. Offers cost-containment suggestions and provides feedback as
needed.
• Provides ongoing education to physicians and staff as well as referring off campus physicians regarding medical necessity
criteria and reimbursement guidelines.
• Maintains reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA, and other federal,
state, and local standards.
• Maintains compliance with all Orlando Health policies and procedures.
Qualifications
Education/Training
• For Team Members hired into this job prior to January 1, 2020:
o Completion of an accredited RN education/training program
o Bachelor's degree
• Effective January 1, 2020: New Hires and Team Members moved into this job and/or transferring Depts. must obtain a
Bachelor of Science in Nursing degree (BSN) within 36 months of placement.
Licensure/Certification
Maintain current RN license in the state of Florida.
Experience
• Five (5) years' acute care experience, OR
• Five (5) years' experience in case management, hospital discharge planning, risk management, quality assurance, and/or
utilization review
