- Molina Healthcare (Miami, FL)
- …At least 2 years clinical nursing experience, including at least 1 year of utilization review , medical claims review , long-term services and supports ... DESCRIPTION **Job Summary** Provides support for medical claim and internal appeals review activities -...or equivalent combination of relevant education and experience. + Registered Nurse ( RN ). License must… more
- MyFlorida (St. Augustine, FL)
- …all verbal orders, including telephone orders from attending physicians, are reviewed by a registered nurse . If no RN is available, receive all telephone ... SENIOR REGISTERED NURSE SUPV - 50950032 Date:...history must be verifiable. Please attach any credentials you claim (degrees, certifications, etc.) to your application. *Other vacant… more
- MyFlorida (Orlando, FL)
- REGISTERED NURSE Date: Dec 30, 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:… more
- Molina Healthcare (Orlando, FL)
- For this position we are seeking a ( RN ) Registered Nurse who...for a RN with experience with appeals, claims review , and medical coding. ... authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted… more
- CVS Health (Tallahassee, FL)
- …Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... virtual training.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS...setting. + A Registered Nurse that holds an active, unrestricted… more
- Sedgwick (Tallahassee, FL)
- …providers to support the claim request and documents decision rationale. + Completes medical review of all claims by reviewing medical documentation ... clinical evaluations on claims that require additional review based on medical condition, client requirement,... management of claims including comprehension of medical terminology and substantiating claim decisions. **ADDITIONAL… more
- Elevance Health (FL)
- …and efficiency recommendations. **Minimum Requirements:** + Requires current, active, unrestricted Registered Nurse license in applicable state(s). + Requires a ... experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing… more
- Highmark Health (Tallahassee, FL)
- …+ 1-3 years of experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or related ... rejection and the proper action to complete the retrospective claim review with the goal of proper...Review process includes a review of medical documentation, itemized bills, and claims data… more
- Zelis (St. Petersburg, FL)
- …inquiries related to provider disputes. + Utilize the most up-to-date approved Zelis medical coding sources for claim review maintenance. + Communicate ... + Serve as subject matter expert for the Expert Claim Review Team on day-to-day activities including...CCS, CIC,RHIA , RHIT, CPC or equivalent credentialing). + Registered Nurse licensure preferred + Bachelor's Degree… more
- Aveanna Healthcare (Miami, FL)
- RN Clinical Director of Operations 10k Sign On Bonus ApplyRefer a FriendBack Job Details Requisition #: 212498 Location: Miami, FL 33166 Category: Nursing Salary: ... plan ** Offering: 10k Sign On Bonus Position Overview: TheHome Health RN Clinical Branch Directoris directly responsible for the administrative and leadership… more