- 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
- 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
- Elevance Health (Tampa, FL)
- ** Nurse Appeals ** **Hybrid 1:** This role.../grievances/quality of care issues and is a resource for clinical and non clinical team members in ... employment, unless an accommodation is granted as required by law._ The ** Nurse Appeals ** is responsible for investigating and processing and medical necessity … more
- Molina Healthcare (Tampa, FL)
- …resource for Utilization Management, Chief Medical Officers, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training and support to clinical ... (Team will work on set schedule) Looking for a RN with experience with appeals , claims review, and medical coding. **Job Summary** Utilizing clinical knowledge… more
- Elevance Health (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 (Orlando, FL)
- …national, state, and local laws and regulatory requirements affecting the medical and clinical staff. + Marketplace UM reviews + MD licenses required for the ... medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse… more
- Veterans Affairs, Veterans Health Administration (Bay Pines, FL)
- … nurse practitioners, physician assistants, psychologists, psychiatrists, social workers, clinical pharmacists, and nursing staff) to accomplish team goal setting ... processing all requests from VA Regional Offices to include appeals board for Compensation and Pension (C&P), to Environment...and the flexible use of a wide range of clinical flow processes relating to access to care across… more