- Lincoln Financial (Tallahassee, FL)
- …at a Glance** We are excited to bring on highly motivated Short Term Disability Claims Specialists to staff our ever-growing claims organization. As a Short Term ... home, then please read on! Click the following link Claims Specialist Job Preview (https://marketingmedia.lfg.com/lfg/DOCS/lfd/emailMarketing/Video/6369162297112.html) to see a realistic… more
- Sedgwick (Tallahassee, FL)
- …Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Quality Review Nurse **PRIMARY PURPOSE** : To monitor team and colleague technical ... line of business experience in telephonic case management (TCM) and/or utilization review or equivalent combination of education and experience required. **Skills &… more
- Elevance Health (Tampa, FL)
- …guidelines and to identify opportunities for fraud and abuse prevention and control. + Review and conducts analysis of claims and medical records prior to ... **Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU**...Skills, Qualifications, and Experiences:** + Fraud and Abuse experienced Nurse with a CPC are highly desired. For candidates… more
- AdventHealth (Tampa, FL)
- …contribute:** The role of the Emergency Department Utilization Management (UM) Registered Nurse (RN) is to use clinical expertise by analyzing patient records to ... order or a status conflict is indicated, the UM nurse is responsible for escalation to the Physician Advisor...to the Physician Advisor or designated leader for additional review as determined by department standards. The Utilization Management… more
- NHS Management, LLC (Tallahassee, FL)
- …they experience along the way. We are in search of a qualified Regional Nurse Consultant: The Regional Nurse Consultant will be responsible for the dissemination ... areas that need improvements or change. 3. Eliminate/reduce resident liability claims through use of corporate policies and established customer service program.… more
- Molina Healthcare (Tampa, FL)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, or ... outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases… more
- CVS Health (Tallahassee, FL)
- …frontline advocates for members who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current case management ... must have an active and unrestricted Compact Licensed Practical Nurse (LPN) License in state of residence + 3+...state of residence + 3+ years of Licensed Practical Nurse (LPN) nursing experience + 2+ years of discharge… more
- Elevance Health (Miami, FL)
- **Telephonic Nurse Case Manager II** **Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... in different states; therefore, Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the… more
- Molina Healthcare (Miami, FL)
- …experience, including hospital acute care/medical experience (STRONGLY DESIRED)** + **Registered Nurse with Claims and CIC coding experience (STRONGLY DESIRED)** ... **_For this position we are seeking a (RN) Registered Nurse who must be licensed for the state of...Payment Integrity strategies through both pre-payment and post payment claims reviews, aligning with industry and corporate standards as… more
- Sedgwick (Tallahassee, FL)
- …and investigates cases accordingly. + Interviews practitioners involved in medical malpractice claims . + Participates in follow-up review and investigation as ... PURPOSE OF THE ROLE:** Investigate, analyze and evaluate medical malpractice claims to assess liability issues and exposure. Reviews medical records, interviews… more