- Centene Corporation (Spring Hill, FL)
- …improve provider performance in areas of Quality, Risk Adjustment and Operations ( claims and encounters). + Assists in delivering provider specific metrics and ... of the following is preferred:** Certified Coding Specialist (CCS), Licensed Practical Nurse (LPN), Licensed Master Social Work (LMSW), Licensed Vocational Nurse … more
- Zelis (St. Petersburg, FL)
- …who you are. Position Overview The Manager, DRG Validation of the Expert Claims Review (ECR) department is responsible for daily operations and team management of ... to Zelis standards regarding privacy What you'll bring to Zelis: + Registered Nurse licensure required + Inpatient Coding Certification required (ie, CCS, CIC, RHIA,… more
- Sedgwick (West Palm Beach, FL)
- …to advance to the next round, a recruiter will be in touch. \# nurse #fieldcasemanager Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. **If ... for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The… more
- HCA Healthcare (Atlantis, FL)
- …of the clinical risk and patient safety program on a day-to-day basis and claims management program and risk management education for the facility. Able to follow ... exposure. Responsible for coordinating activities that focus on the management of claims and pretrial preparation. Also responsible for the grievance process and the… 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. ... 30-day hospital readmissions. **Required Qualifications** - Active and unrestricted Licensed Practical Nurse (LPN) in state of residence - Must possess compact LPN… more
- Cleveland Clinic (Stuart, FL)
- …department leader or experienced CRMs. + Identifies cases that may be potential claims and provides an early notification to other departments (Law, ERI) once ... CRM department process. + Other duties as assigned. **Education:** + Registered Nurse (BSN) or bachelor's degree in a health sciences discipline is required.… more
- Public Consulting Group (Tallahassee, FL)
- …Third Party Administrator Services + Enhance Health and Public Safety Services + Claims Processing Services and Solutions + Consulting and Advisory Services + Cost ... Proven working experience in case management, including as a nurse , medical, mental health care manager or a related...+ Current license, certification or registration as a Registered Nurse or Social Worker **Working Conditions** + Office Setting… more
- Morley (Miami, FL)
- …to Make Your Life Easier_** + Teladoc: 24/7 online access to doctors + 24/7 nurse help desk + Patient advocacy: Free 24/7 help with benefit questions and claims ... issues + Family, financial and estate guidance (will) services **_About Morley_** Our mission is to deliver extraordinary experiences. We do this by leading with humility, embracing everyone, sweating the details and moving mountains (making the impossible… more
- HCA Healthcare (Trinity, FL)
- …members on analysis of risk assessment, historical and concurrent occurrence and claims data and national trends. .You will ensure responsibility for organizational ... field required; Master's Degree preferred .Current Florida licensure as a Registered Nurse preferred _**If serving as facility's primary Risk Manager, VP must have… more
- HCA Healthcare (Niceville, FL)
- …HCA Florida Twin Cities Hospital, our nurses play a vital part. We know that every nurse 's path and purpose is unique. Do you want to create your own personal career ... inservices. Ensures the timely processing of employee workers' compensation claims ; evaluates occurrence reports to determine accuracy and completeness. Assesses… more