- 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
- Veterans Affairs, Veterans Health Administration (Orlando, FL)
- …RXs, Care in the Community, DME, and Ambulance. Conducts clinical legal relatedness review for Regional Counsel TORT Claims , No Fault, and Worker's Compensation ... integration of VHA and industry best standards. Responsibilities Responsibilities of the RUR Nurse Manager (NM) include, but are not limited, to the following: RUR … more
- MyFlorida (Orlando, FL)
- SENIOR REGISTERED NURSE SUPV 1 Date: Sep 9, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... . Requisition No: 857206 Agency: Veterans Affairs Working Title: SENIOR REGISTERED NURSE SUPV 1 Pay Plan: Career Service Position Number: 50556022 Salary: $72,113.08… more
- MyFlorida (Orlando, FL)
- REGISTERED NURSE Date: Sep 5, 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: Sep 4, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... . Requisition No: 856173 Agency: Veterans Affairs Working Title: REGISTERED NURSE Pay Plan: Career Service Position Number: 50453000 Salary: $67,742.74 Posting… more
- MyFlorida (Pembroke Pines, FL)
- OPS REGISTERED NURSE - 50509374 Date: Sep 9, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... . Requisition No: 854613 Agency: Veterans Affairs Working Title: OPS REGISTERED NURSE - 50509374 Pay Plan: Health Care Practice Position Number: 50509374 Salary:… more
- CVS Health (Tallahassee, FL)
- …within time zone of residence.** 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
- Humana (Tallahassee, FL)
- …action. + Complete medical record reviews + Assess discharge plans + Review and extract information from claims + Complete documentation for Quality Reviews ... the appropriate courses of action. The Utilization Management Behavioral Health Nurse 2 completes medical record reviews from medical records sent from… more
- Molina Healthcare (Tampa, FL)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... the likelihood of a formal appeal being submitted. + Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge,… more
- NHS Management, LLC (Tallahassee, FL)
- …risk management policies to include reviews of significant events/unusual occurrences and a review of the medical record. We offer the following benefits for ... way. We are in search of a qualified Regional Nurse Consultant: The Regional Nurse Consultant will...that need improvements or change. 3. Eliminate/reduce resident liability claims through use of corporate policies and established customer… more
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