- 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
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …improve clinical outcomes. + Collaborate with internal stakeholders including the Chief Medical Officer, Provider Relations, Claims , and IT to ensure seamless ... Coordinator RNs, Medical Management Coordinators. + Manages the daily concurrent review process through department staff, including review of daily hospital… more
- Elevance Health (Miami, FL)
- …Capabilities and Experiences:** + **Operating room and/or auditing experience highly preferred.** + ** Medical claims review with prior health care fraud ... you will make an impact:** + Investigates potential fraud and over-utilization by performing medical reviews via prepayment claims review and post payment… more
- Elevance Health (Tampa, 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
- Sedgwick (Tampa, 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
- Sedgwick (Tallahassee, FL)
- …Best Workplaces in Financial Services & Insurance Nurse Allocator- RN Medicare Compliance **Prior medical -set-aside experience highly desired for this ... **PRIMARY PURPOSE OF THE ROLE:** To perform provider outreach, specialized document review , and analysis and interpretation of interventions for the preparation of… more
- Aveanna Healthcare (Miami, FL)
- Home Health RN Clinical Director of Operations ApplyRefer a FriendBack Job Details Requisition #: 208380 Location: Miami, FL 33166 Category: Nursing Salary: ... Management/Issue Resolution * Plan and implement branch growth strategies * Thorough review of financial statements, activity reports, and other performance data to… more
- Zelis (FL)
- …Guidelines, AHA Coding Clinic and client specific coverage policies. Conduct prompt claim review to support internal inventory management to achieve greatest ... plan, and policy exclusions. Conduct reviews on inpatient DRG claims as they compare with medical records...standards regarding privacy What you'll bring to Zelis: + Registered Nurse licensure preferred + Inpatient Coding… more
- Lincoln Financial (Tallahassee, FL)
- …**What we're looking for** Education * 4 Year/Bachelor's Degree in Nursing * Registered Nurse License - Current, unrestricted license in the state where ... organization. This position will be responsible for reviewing, analyzing, and interpreting medical information available for disability claims . In this role you… more
- Elevance Health (Tampa, FL)
- …enforcement referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy claims . + Responsible for independently ... Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Investigator Senior** is responsible for the independent… more