• Medical Review Nurse (RN)

    Molina Healthcare (Orlando, FL)
    … Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM), ... and support to clinical peers. + Identifies and refers members with special needs to the appropriate Molina program per applicable policies/protocols. **Job… more
    Molina Healthcare (12/26/25)
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  • Senior Auditor, Delegation Oversight

    Molina Healthcare (Orlando, FL)
    …Clinical Coder (CCD), Certified Medical Audit Specialists (CMAS), Certified Professional in Healthcare Management (CPHM) and/or other health care ... a team, support multiple projects at once, and perform other duties or special projects as required. * Ability to collaborate cross-functionally across a highly… more
    Molina Healthcare (12/17/25)
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  • Payment Integrity Clinician

    Highmark Health (Tallahassee, FL)
    …Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or related **SKILLS** + Demonstrated ability ... SUMMARY** This job requires the ability to identify issues related to professional and facility provider claims data including determining appropriateness of code… more
    Highmark Health (11/14/25)
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  • Clinical Fraud Investigator II - Registered Nurse…

    Elevance Health (FL)
    …Requirements:** + Requires an Associate Degree in Nursing and/or current certification as a Certified Professional Coder (AAPC or AHIMA) and minimum of 4 ... necessary to aid in investigations. + Collaborates with the Special Investigation Unit and other internal areas on matters...our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors… more
    Elevance Health (12/18/25)
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