• Medical Claim Review Nurse (RN)

    Molina Healthcare (Tampa, FL)
    …Looking for a RN with experience with appeals, claims review, and medical coding . **Job Summary** Utilizing clinical knowledge and experience, responsible for ... Medical Surgical, or Pediatrics. Advanced Practice Nursing. Billing and coding experience. **PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:** Certified Clinical … more
    Molina Healthcare (09/06/25)
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  • Medical Director-Payment Integrity

    Humana (Tallahassee, FL)
    …discussions with an external provider. Some roles include an overview of coding practices and clinical documentation, dispute/grievance and appeals processes, ... and work is assisted by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical reference materials,… more
    Humana (09/26/25)
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  • Medical Director - Claims Management

    Humana (Tallahassee, FL)
    …may require conflict resolution skills. Some roles include an overview of coding practices and clinical documentation, dispute, grievance, and appeals processes, ... and work is assisted by diverse resources, which may include national clinical guidelines, CMS and state policies and determinations, clinical reference… more
    Humana (09/17/25)
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  • Medical Director - Southeast Region

    Humana (Tallahassee, FL)
    …these may require conflict resolution skills. Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and ... and work is assisted by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical reference materials,… more
    Humana (09/10/25)
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  • Clinical Provider Auditor II

    Elevance Health (Tampa, FL)
    ** Clinical Provider Auditor II** **Hybrid 1:** This role requires associates to be in-office **1 - 2** days per week, fostering collaboration and connectivity, while ... determined to recover, eliminate and prevent unnecessary medical-expense spending. The ** Clinical Provider Auditor II i** s responsible for identifying issues and/or… more
    Elevance Health (09/30/25)
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  • Clinical Documentation Integrity Specialist…

    AdventHealth (Altamonte Springs, FL)
    …**The role you will contribute:** Under general supervision of the Director of Clinical Documentation Integrity and in some situations the supervision of the ... Clinical Documentation Integrity Manager, and in collaboration with physicians,...them to resolves discrepancies with DRG assignments and other coding issues. . Completes well-timed follow-up case reviews on… more
    AdventHealth (09/26/25)
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  • Clinical Provider Auditor II

    Elevance Health (Miami, FL)
    ** Clinical Provider Auditor II** **Supports the Payment Integrity line of business** **Hybrid 1** : This role requires associates to be in-office **1-2** days per ... determined to recover, eliminate and prevent unnecessary medical-expense spending. The ** Clinical Provider Auditor II** is responsible for identifying issues and/or… more
    Elevance Health (09/06/25)
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  • Clinical Documentation Integrity Team Lead…

    AdventHealth (Tampa, FL)
    …Research Institute, also located at AdventHealth Tampa, leads the way in clinical and academic research in the areas of neuroscience, cardiovascular medicine, ... and other diseases. **The ro** **le you'll contribute:** Oversees site-based Clinical Documentation Integrity (CDI) program; monitors and maintains the timeliness of… more
    AdventHealth (08/14/25)
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  • RN Clinical Appeals Nurse

    Molina Healthcare (Orlando, FL)
    **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical decisions for appeals outcomes within compliance ... standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical /medical reviews...pharmacy, etc.). + Experience demonstrating knowledge of ICD-9, CPT coding and HCPC. + Experience demonstrating knowledge of CMS… more
    Molina Healthcare (09/26/25)
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  • Clinical Documentation Manager

    AdventHealth (Orlando, FL)
    …States and the world. All within a 'living laboratory' of groundbreaking, research-driven clinical solutions that integrate mind, body and spirit in the defeat of ... illness and disease **The role you'll contribute:** The Clinical Documentation Integrity Manager is a Registered Nurse and/or...to all CDI staff; extensive knowledge of I10 and coding guidelines. + Develops, produces, and delivers training for… more
    AdventHealth (09/12/25)
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