- AdventHealth (Riverview, FL)
- …be caring for:** AdventHealth Riverview AdventHealth is expanding our medical expertise, innovation, and state-of-the-art technology to southern Hillsborough County ... million project in Riverview also includes a 100,000 square foot, four-story Medical Office Building that will provide community members convenient access to expert… more
- MyFlorida (Orlando, FL)
- SENIOR REGISTERED NURSE SUPV Date: Nov 18, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... . Requisition No: 863569 Agency: Veterans Affairs Working Title: SENIOR REGISTERED NURSE SUPV Pay Plan: Career Service Position Number: 50556022 Salary: $72,113.08… more
- CVS Health (Tallahassee, FL)
- …it all with heart, each and every day. **Position Summary** The Quality Management Nurse (QM Nurse ) supports Aetna Better Health of Texas by ensuring compliance ... clinical expertise with quality improvement leadership, including clinical documentation review , Performance Improvement Projects (PIPs), ANE oversight, and policy… more
- MyFlorida (Orlando, FL)
- REGISTERED NURSE Date: Dec 1, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... . Requisition No: 860343 Agency: Veterans Affairs Working Title: REGISTERED NURSE Pay Plan: Career Service Position Number: 50009834 Salary: $67,742.74 Posting… more
- Molina Healthcare (Orlando, FL)
- …managed care experience in the specific programs supported by the plan such as utilization review , medical claims review , long-term services and supports ... **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support for internal appeals clinical...likelihood of a formal appeal being submitted. * Reevaluates medical claims and associated records independently by… more
- CVS Health (Tallahassee, FL)
- …implementing, and coordinating all case management activities with members to evaluate the medical needs of the member and to help facilitate the member's overall ... - Through the use of clinical tools and information/data review , conducts an evaluation of member's needs and benefit...and multiple diagnoses that impact functionality. - Reviews prior claims to address potential impact on current case management… more
- Travelers Insurance Company (Tampa, FL)
- …case resolution. + Review , approve and issue accurate and timely indemnity, medical and expense payments for lifetime/long-term claims . + Determine Value of ... 1 **What Is the Opportunity?** Under moderate supervision, manage Workers' Compensation Claims with: Stable Lifetime Indemnity and/or Medical Benefits where the… more
- Humana (Tallahassee, FL)
- …+ Cross train in Physical Health Provider Disputes based on the business need + Review and extract information from claims + Work in partnership with other ... and help us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and… more
- Elevance Health (Tampa, FL)
- ** Nurse Case Manager II** **Location** : This role enables associates to work virtually full-time, with the exception of required in-person training sessions, ... 48 hours of receipt and meet the criteria._** The ** Nurse Case Manager II** is responsible for care management...management plan and modifies as necessary. + Interfaces with Medical Directors and Physician Advisors on the development of… more
- Elevance Health (Tampa, FL)
- **Telephonic Nurse Case Manager II** **Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... hours of receipt and meet the criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management...management plan and modifies as necessary. + Interfaces with Medical Directors and Physician Advisors on the development of… more