- Molina Healthcare (Jacksonville, FL)
- JOB DESCRIPTION **Job Summary** The RN Clinical Appeals Nurse provides support for internal appeals clinical processes - ensuring that appeals ... regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. Assesses appropriateness of services, length of stay and… more
- BayCare Health System (Clearwater, FL)
- …team member be working remotely?** Hybrid Equal Opportunity Employer Veterans/Disabled **Position** Clinical Appeals Nurse - Health Plan **Location** ... of experience with case management and/or clinical appeals or claims. + Registered Nurse **Facility:**...clinical appeals or claims. + Registered Nurse **Facility:** BayCare Health System, Admin - Non Hospital… more
- Elevance Health (FL)
- ** Nurse Appeals - Litigation & Legal...Review requests. + Acts as a resource for both clinical and non- clinical teams, by managing and ... will be necessary and is dependent on court hearing schedules. The ** Nurse Appeals - Litigation & Legal Support** is responsible for investigating and processing… more
- Evolent (Tallahassee, FL)
- …to Standard processing, documenting accordingly. + Works closely with the appeals -dedicated Clinical Reviewers to ensure timely adjudication of processed ... for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a...be able to exercise independent and sound judgment in clinical decision making. - **Preferred** + Able to navigate… more
- Cognizant (Tallahassee, FL)
- …cycle or clinic operations + Experience in utilization management to include Clinical Appeals and Grievances, precertification, initial and concurrent reviews + ... have to be considered** + Educational background - Registered Nurse (RN) + 2-3 years combined clinical ...stand out** + Epic experience + Experience in drafting appeals disputing inpatient clinical validations audits is… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- Position is On-Site The Behavioral Health Nurse - Managed Care is responsible for coordinating, monitoring, and delivering behavioral health services within a ... community resources. + Authorize services and coordinate referrals based on clinical guidelines and insurance coverage. + Provide telephonic and/or in-person case… more
- Elevance Health (Miami, FL)
- ** Clinical Operations Medical Director** **Medical Oncology** **Carelon Medical Benefit Management** **Virtual** : This role enables associates to work virtually ... Our platform delivers significant cost-of-care savings across an expanding set of clinical domains, including radiology, cardiology and oncology._ The ** Clinical … more
- Molina Healthcare (Tampa, FL)
- …medical necessity. * Participates in and maintains the integrity of the appeals process, both internally and externally. * Responsible for investigation of adverse ... and consultation for NCQA standards/guidelines for the plan including compliant clinical quality improvement activity (QIA) in collaboration with clinical … more
- Molina Healthcare (Orlando, FL)
- For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity of high ... (Team will work on set schedule) Looking for a RN with experience with appeals , claims review, and medical coding. JOB DESCRIPTION Job SummaryProvides support for … more