- Cognizant (Tallahassee, FL)
- …, and retro-authorization as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral, preauthorization, ... cycle or clinic operations . Experience in utilization management to include Clinical Appeals and Grievances, precertification, initial and concurrent reviews .… 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...work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators… more
- Elevance Health (Tampa, FL)
- ** Nurse Appeals ** **Hybrid 1:** This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing ... an accommodation is granted as required by law._ The ** Nurse Appeals ** is responsible for investigating and...medical information for medical director, consultants and other external review . + Prepares recommendations to either uphold or deny… more
- Molina Healthcare (Tampa, FL)
- …set schedule) Looking for a RN with experience with appeals , claims review , and medical coding. **Job Summary** Utilizing clinical knowledge and experience, ... identified by the Payment Integrity analytical team; requires decision making pertinent to clinical experience + Documents clinical review summaries, bill… more
- Elevance Health (FL)
- …members and providers. **How you will make an impact:** + Perform physician-level case review , following initial nurse review , of Medical Oncology regimens ... ** Clinical Operations Medical Director** **Medical Oncology** **Carelon Medical...and supportive care. + Perform physician-level case review , following initial nurse review ,… more
- Molina Healthcare (Orlando, FL)
- …the Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the ... local laws and regulatory requirements affecting the medical and clinical staff. + Marketplace UM reviews + MD licenses...+ Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the… 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 ... is responsible for processing all requests from VA Regional Offices to include appeals board for Compensation and Pension (C&P), to Environment of Care, Burn Pit,… more