- Elevance Health (Tampa, FL)
- …fraud and abuse prevention and control. + Review and conducts analysis of claims and medical records prior to payment. Researches new healthcare-related ... **Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU**...Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Clinical Fraud Investigator II** is responsible… more
- Otsuka America Pharmaceutical Inc. (Tallahassee, FL)
- The Patient Nurse Case Manager (PNCM) is a dynamic, field-based role that serves as a crucial educator for patients. This position helps to execute against a ... with states and local laws. **Company benefits** : Comprehensive medical , dental, vision, prescription drug coverage, company provided basic...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
- Sedgwick (Tallahassee, FL)
- …to Work(R) Fortune Best Workplaces in Financial Services & Insurance Quality Review Nurse **PRIMARY PURPOSE** : To monitor team and colleague technical and quality ... + Strong team and customer service orientation + Three Medical , and two dental plans to choose from. +...or health savings account, and other additional voluntary benefits._ \# nurse Sedgwick is an Equal Opportunity Employer and a… more
- Molina Healthcare (Tampa, FL)
- …the likelihood of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge, ... Experience in the specific programs supported by the plan such as Utilization Review, Medical Claims Review, Long Term Service and Support, or other specific… more
- CVS Health (Tallahassee, FL)
- …members who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current case management and eligibility status. ... Qualifications** + Candidate must have an active and unrestricted Compact Licensed Practical Nurse (LPN) License in state of residence + 3+ years of Licensed… more
- NHS Management, LLC (Tallahassee, FL)
- …they experience along the way. We are in search of a qualified Regional Nurse Consultant: The Regional Nurse Consultant will be responsible for the dissemination ... areas that need improvements or change. 3. Eliminate/reduce resident liability claims through use of corporate policies and established customer service program.… more
- Elevance Health (Tampa, FL)
- ** Nurse Case Manager I** **Schedule:** Monday - Friday, 8am-4:30pm EST **Virtual** **:** This role enables associates to work virtually full-time, with the exception ... an accommodation is granted as required by law._ The ** Nurse Case Manager I** is responsible for performing care...management plan and modifies as necessary. + Interfaces with Medical Directors and Physician Advisors on the development of… more
- Elevance Health (Miami, FL)
- ** Nurse Case Manager I** **Location** : This role enables associates to work virtually full-time, with the exception of required in-person training sessions, ... candidate must reside in the state of Florida.** The ** Nurse Case Manager I** 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 (Miami, FL)
- **Telephonic Nurse Case Manager II** **Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... in different states; therefore, Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the… more
- Polk County Public Schools (Bartow, FL)
- **Position Title:** Nurse , RN **FLSA Status:** Exempt **Salary Grade, if non-union:** **Pay Grade, if union:** Teacher Salary Schedule **Non-Union or Specific ... perform personal care procedures (eg, catheterization) and perform and/or supervise medical procedures (eg, tracheotomy care) on students and train appropriate… more