- BayCare Health System (Clearwater, FL)
- …working remotely?** Hybrid Equal Opportunity Employer Veterans/Disabled **Position** Clinical Appeals Nurse - Health Plan **Location** Clearwater:Park ... years of experience with case management and/or clinical appeals or claims. + Registered Nurse **Facility:** BayCare Health System, Admin - Non Hospital… more
- Elevance Health (FL)
- ** Nurse Appeals - Litigation & Legal...Review requests. + Acts as a resource for both clinical and non- clinical teams, by managing and ... necessary and is dependent on court hearing schedules. The ** Nurse Appeals - Litigation & Legal Support**...Current active unrestricted RN license to practice as a health professional within the scope of licensure in applicable… more
- Evolent (Tallahassee, FL)
- …to appropriate internal reviewers according to the business needs of the particular health plan. + Reviews requests for Urgent appeals compared to expedited ... to Standard processing, documenting accordingly. + Works closely with the appeals -dedicated Clinical Reviewers to ensure timely adjudication of processed… more
- Cognizant (Tallahassee, FL)
- …+ Educational background - Registered Nurse (RN) + 2-3 years combined clinical and/or utilization management experience with managed health care plan + 3 ... related to clinical denial management and managing clinical denials from Providers to the Health ...clinic operations + Experience in utilization management to include Clinical Appeals and Grievances, precertification, initial and… more
- Molina Healthcare (Orlando, FL)
- …a clinical resource for utilization management, CMOs, physicians and member/provider inquiries/ appeals . + Provides training and support to clinical peers. + ... **Job Description** **Job Summary** Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal… more
- Elevance Health (Miami, FL)
- ** Clinical Operations Medical Director** **Medical Oncology** **Carelon Medical Benefit Management** **Virtual** : This role enables associates to work virtually ... is granted as required by law._ _A proud member of the Elevance Health family of companies, Carelon Medical Benefits Management, formerly AIM Specialty Health… more
- Sharecare (Tallahassee, FL)
- …available 3rd parties for care management and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and ... **Job Description:** Sharecare is the leading digital health company that helps people - no matter...new hire plan selection, claims issues, ID card issues, grievances/ appeals , utilization management (UM) status, including but not limited… more
- Molina Healthcare (Tampa, FL)
- …care. Essential Job Duties * Determines appropriateness and medical necessity of health care services provided to plan members. * Supports plan utilization ... medical necessity. * Participates in and maintains the integrity of the appeals process, both internally and externally. * Responsible for investigation of adverse… more