• Appeals Nurse Reviewer I

    Elevance Health (FL)
    ** Appeals Nurse Reviewer I**...Outreach to providers with appeal process instructions. + Clinical review for the RBM and Surgical solution on a ... set of clinical domains, including radiology, cardiology and oncology. The ** Appeals Nurse Reviewer I** is responsible for conducting preauthorization, out… more
    Elevance Health (09/26/25)
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  • Medical Claim Review Nurse (RN)

    Molina Healthcare (Tampa, FL)
    …(Team will work on set schedule) Looking for a RN with experience with appeals , claims review , and medical coding. **Job Summary** Utilizing clinical knowledge ... and experience, responsible for review of documentation to ensure medical necessity and appropriate level of care utilizing MCG/InterQual, state/federal guidelines,… more
    Molina Healthcare (09/06/25)
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  • Medical Director - Medical Oncology

    Elevance Health (FL)
    …members and providers. **How you will make an impact:** + Perform physician-level case review , following initial nurse review , of Medical Oncology regimens ... and supportive care. + Perform physician-level case review , following initial nurse review ,...a subject matter expert. + Perform first level provider appeals as designated by the client for adverse determinations.… more
    Elevance Health (09/27/25)
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  • Medical Director

    Centene Corporation (Tallahassee, FL)
    …cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , quality assurance, and ... optimize outcomes. + Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and… more
    Centene Corporation (10/03/25)
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  • Customer Service Representative - Work From Home…

    CVS Health (Tallahassee, FL)
    …in accordance with contract. -Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) ... Aetna's Law Document Center regarding litigation; lawsuits. -Handles extensive file review requests. -Assists in preparation of complaint trend reports. -Assists in… more
    CVS Health (09/27/25)
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  • Medical Director (AZ)

    Molina Healthcare (Orlando, FL)
    …the Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the ... medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse… more
    Molina Healthcare (09/26/25)
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  • Associate Manager, Clinical Health Services…

    CVS Health (FL)
    …with other key business areas. + May develop/assist in development and/ review new training content. + May collaborate/deliver inter and intra-departmental training ... + 5+ years of acute experience as a Registered Nurse + 3+ years of Utilization Management experience +...years of Utilization Management experience + 3+ year(s) of Appeals experience in Utilization Management + Must have experience… more
    CVS Health (10/02/25)
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