- Travelers Insurance Company (Orlando, FL)
- …internal and/or external resources for specific activities required to effectively evaluate claims , such as Subrogation, Risk Control, nurse consultants, and ... and resolving assigned General Liability related Bodily Injury and Property Damage claims . Provides quality claim handling throughout the claim life cycle (customer… more
- Sedgwick (Tallahassee, FL)
- …and assessment with service provider. + Calls treating physicians to conduct a peer review of medications used on specific claims and provides insight for drug ... team on difficult cases. + Consults with pharmacy UR team for difficult claims requiring weaning schedule. + Assesses needs, gives appropriate clinical options, and… more
- Sedgwick (Tallahassee, FL)
- …for absence from work. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Performs clinical review of referred claims ; documents decision rationale; and completes ... medical review of all claims to ensure information substantiates disability. + Provides clear...change the duties of the position at any time. \# nurse #casemanagementspecialist Sedgwick is an Equal Opportunity Employer and… more
- Elevance Health (Tampa, FL)
- …clinical documentation supports the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims . **How you will ... make an impact:** + Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines, and objectivity in the performance of medical… more
- Centene Corporation (Spring Hill, FL)
- …improve provider performance in areas of Quality, Risk Adjustment and Operations ( claims and encounters). + Assists in delivering provider specific metrics and ... work experience within a managed care environment related to HEDIS record review , quality improvement, medical coding or transferable skill sets that demonstrates… more
- Zelis (St. Petersburg, FL)
- …shape who you are. Position Overview The Manager, DRG Validation of the Expert Claims Review (ECR) department is responsible for daily operations and team ... to Zelis standards regarding privacy What you'll bring to Zelis: + Registered Nurse licensure required + Inpatient Coding Certification required (ie, CCS, CIC, RHIA,… 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 ... 30-day hospital readmissions. **Required Qualifications** - Active and unrestricted Licensed Practical Nurse (LPN) in state of residence - Must possess compact LPN… more
- Public Consulting Group (Tallahassee, FL)
- …Third Party Administrator Services + Enhance Health and Public Safety Services + Claims Processing Services and Solutions + Consulting and Advisory Services + Cost ... and client-centered + Handles case assignments, draft service plans, review case progress and determine case closure + Travels...Proven working experience in case management, including as a nurse , medical, mental health care manager or a related… more
- Molina Healthcare (FL)
- …the Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the ... focused reviews and recommends corrective actions. + Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care.… more
- GE Vernova (Pensacola, FL)
- …to Customs. + Active engagement of pre and post shipment audit review , inclusive of valuation, classification, country of origin and applicable special program ... Conduct internal training specific to Customs operations. + Support active review and revisions of business policies, procedures and manuals associated with… more