- Molina Healthcare (Orlando, FL)
- …managed care experience in the specific programs supported by the plan such as utilization review , medical claims review , long-term services and supports ... likelihood of a formal appeal being submitted. * Reevaluates medical claims and associated records independently by...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Carnival Cruise Line (Miami, FL)
- …health team to assess fitness for duty per International Maritime Health guidelines. + **Crew Medical Claims Management** + Review crew cases of high risk ... return-to-work planning in compliance with regulations and employment obligations. + Support disability claims and benefits review for crew unable to return to… more
- Molina Healthcare (FL)
- …Microsoft Excel (edit/save spreadsheets, sort/filter) **Required License, Certification, Association** Licensed registered nurse ( RN ), Licensed practical ... internal policies, and contract requirements. This position completes a medical review to facilitate a referral to...corresponding medical records to determine accuracy of claims payments. + Review of applicable policies,… 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
- 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
- Sedgwick (Orlando, FL)
- … review of referred claims ; documents decision rationale; and completes medical review of all claims to ensure information substantiates disability. ... + Provides clear and appropriate follow-up recommendations for ongoing medical management of claims ; ensures appropriate recommendations are made on claims .… more
- Aveanna Healthcare (Miami, FL)
- RN Clinical Director of Operations 10k Sign On Bonus ApplyRefer a FriendBack Job Details Requisition #: 209130 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
- Aveanna Healthcare (Brandon, FL)
- Home Health RN Executive Director ApplyRefer a FriendBack Job Details Requisition #: 209054 Location: Brandon, FL 33509 Category: Nursing Salary: $90,000.00 - ... * Plan and implement branch growth strategies * Thorough review of financial statements, activity reports, and other performance...if internal billing and collection efforts to generate clean claims * Perform other duties as assigned Why Join… more
- Aveanna Healthcare (Deland, FL)
- Home Health RN Executive Director of Operations ApplyRefer a FriendBack Job Details Requisition #: 208819 Location: Deland, FL 32720 Category: Nursing Salary: ... * Plan and implement branch growth strategies * Thorough review of financial statements, activity reports, and other performance...if internal billing and collection efforts to generate clean claims Aveanna Healthcare Offers: * 401(k) with match *… more
- HCA Healthcare (Kissimmee, FL)
- …improvement and develops effective mitigation strategies. **What qualifications you will need:** + ( RN ) Registered Nurse + Bachelors Degree HCA Florida ... Assists appropriate medical staff and nursing committees in the resolution of peer review , medical quality of care and nursing quality of care issues posing… more