- 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
- 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 ... you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to...legitimate job opportunity. Scammers may also send offers or claims from a fake email address or from Yahoo,… 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
- 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
- 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 ... to students including, but not limited to, any insurance or Medicaid claims . **Non-Essential Functions of this Job** Performs other duties as assigned. **Knowledge,… more