- Molina Healthcare (Miami, FL)
- …experience, including hospital acute care/medical experience (STRONGLY DESIRED)** + **Registered Nurse with Claims and CIC coding experience (STRONGLY DESIRED)** ... **_For this position we are seeking a (RN) Registered Nurse who must be licensed for the state of...Payment Integrity strategies through both pre-payment and post payment claims reviews, aligning with industry and corporate standards as… more
- Lincoln Financial (Tallahassee, FL)
- …at a Glance** We are excited to bring on highly motivated Short Term Disability Claims Specialists to staff our ever-growing claims organization. As a Short Term ... home, then please read on! Click the following link Claims Specialist Job Preview (https://marketingmedia.lfg.com/lfg/DOCS/lfd/emailMarketing/Video/6369162297112.html) to see a realistic… more
- Elevance Health (Tampa, FL)
- **Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU** **Location:** This role requires associates to be in-office 1 - 2 days ... + Performs in-depth investigations on identified providers as warranted. + Examines claims for compliance with relevant billing and processing guidelines and 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 ... flexible spending or health savings account, and other additional voluntary benefits._ \# nurse Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.… more
- AdventHealth (Tampa, FL)
- …contribute:** The role of the Emergency Department Utilization Management (UM) Registered Nurse (RN) is to use clinical expertise by analyzing patient records to ... align with the physician order or a status conflict is indicated, the UM nurse is responsible for escalation to the Physician Advisor or designated leader for… 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. ... must have an active and unrestricted Compact Licensed Practical Nurse (LPN) License in state of residence + 3+...state of residence + 3+ years of Licensed Practical Nurse (LPN) nursing experience + 2+ years of discharge… 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 ... that need improvements or change. 3. Eliminate/reduce resident liability claims through use of corporate policies and established customer...and Paid Vacation Requirements + Must be a Registered Nurse in good standing + Previous experience in a… more
- Molina Healthcare (Tampa, FL)
- …outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases ... of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge, knowledge 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...treatment plans. + Assists in problem solving with providers, claims or service issues. **Minimum Requirements:** + Requires BA/BS… 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...as applicable. + Assists in problem solving with providers, claims or service issues. **Minimum Requirements:** + Requires BA/BS… more