- Molina Healthcare (Tampa, FL)
- …Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in ... schedule) Looking for a RN with experience with appeals, claims review , and medical coding....clinical/ medical reviews of retrospective medical claim reviews, medical claims and… more
- Evolent (Tallahassee, FL)
- …+ Determines medical necessity and appropriateness of services using clinical review criteria. + Accurately documents all review determinations and contacts ... for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are… more
- MyFlorida (Orlando, FL)
- SENIOR REGISTERED NURSE SUPV Date: Oct 20, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... . Requisition No: 863569 Agency: Veterans Affairs Working Title: SENIOR REGISTERED NURSE SUPV Pay Plan: Career Service Position Number: 50556022 Salary: $72,113.08… more
- MyFlorida (Orlando, FL)
- REGISTERED NURSE Date: Nov 2, 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: 50009834 Salary: $67,742.74 Posting… more
- MyFlorida (Port Saint Lucie, FL)
- REGISTERED NURSE Date: Oct 29, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... . Requisition No: 864225 Agency: Veterans Affairs Working Title: REGISTERED NURSE Pay Plan: Career Service Position Number: 50453000 Salary: $67,742.74 Annually… more
- CVS Health (Tallahassee, FL)
- …in the US with virtual training.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health. Founded in 1993, ... Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support cost-effective quality care for members.… more
- Sedgwick (Tallahassee, FL)
- …to Work(R) Fortune Best Workplaces in Financial Services & Insurance Nurse Allocator- RN Medicare Compliance **Prior Medicare-set-aside (MSA) experience highly ... **PRIMARY PURPOSE OF THE ROLE:** To perform provider outreach, specialized document review , and analysis and interpretation of interventions for the preparation of… more
- Elevance Health (Miami, FL)
- **Telephonic Nurse Case Manager II** **Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... in different states; therefore Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope… more
- Molina Healthcare (St. Petersburg, FL)
- …will work on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. JOB DESCRIPTION Job SummaryProvides support ... For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is...for clinical member services review assessment processes. Responsible for verifying that services are… 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...concepts to expand the DRG product. + Manage assigned claims and claim report, adhering to client… more
Recent Jobs
-
Mid-level WAN Network Administrator - DoD / Cisco / Secret Clearance
- Sumaria Systems, Inc. (Montgomery, AL)
-
Manager, Sales Planning and Reporting
- Paramount (Los Angeles, CA)
-
Field Marketing Manager, Electrophysiology - WEST
- Abbott (Abbott Park, IL)
-
Operations Manager
- Lamar Advertising Company (Tulsa, OK)