- Molina Healthcare (Miami, FL)
- JOB DESCRIPTION **Job Summary** The RN Care Review Clinician provides support for clinical member services review assessment processes. Responsible for ... verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired… more
- Molina Healthcare (Orlando, FL)
- …(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 clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical … more
- Elevance Health (FL)
- …case reviews with attending physicians or other ordering providers to discuss review determinations. + Interprets existing policies or clinical guidelines and ... The **Plan Performance Medical Director** serves as a lead clinician and oversees the administration of medical services for...or territory of the United States when conducting utilization review or an appeals consideration and cannot… more
- Cardinal Health (Tallahassee, FL)
- …**_Job Purpose:_** Revenue Cycle Management focuses on a series of clinical and administrative processes that healthcare providers utilize to capture, bill, ... & payors as needed to obtain updated insurance and/or clinical information. + Submit authorizations for all internal and...any denials received by the payor to inform the clinician of changes that may need to happen to… more
- Cardinal Health (Tallahassee, FL)
- …& payors as needed in order to obtain updated insurance and/or clinical information. + Submit authorizations for all internal and external orders including, ... any denials received by the payor to inform the clinician of changes that may need to happen to...to not delay patient care. + Complete any pre-service appeals to obtain paying approval based on medical necessity.… more