- Elevance Health (Tampa, FL)
- ** Nurse Appeals RN - Quality of Care** **Hybrid 1:** This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and ... Hours:** Monday-Friday, 8:00AM -5:00 PM Eastern Standard Time The ** Nurse Appeals ** is responsible for investigating and...and summarizes medical information for medical director. + Prepares nurse summaries for Quality of Care cases… more
- Evolent (Tallahassee, FL)
- …**Required** + Minimum of 5 years in Utilization Management, health care Appeals , compliance and/or grievances/complaints in a quality improvement environment- ... for the culture. **What You'll Be Doing:** The Specialty Appeals Team offers candidates the opportunity to make a...part of a highly trained dedicated team focusing on appeals and post-determination requests. We maintain the principles of… more
- Molina Healthcare (Jacksonville, FL)
- …and/or coding experience, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... JOB DESCRIPTION **Job Summary** The Medical Claim Review Nurse provides support for medical claim review activities. Responsible for ensuring timely claims payment… more
- Molina Healthcare (Tampa, FL)
- …hours 6 AM to 6 PM (Team will work on set schedule) Looking for a RN with experience with appeals , claims review, and medical coding. **Job Summary** Utilizing ... state/federal regulations **REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:** Active, unrestricted State Registered Nursing ( RN ) license in good standing.… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …initiatives/opportunities for improvement through departmental committee assignments. Qualifications: + Registered Nurse , Licensed Practical Nurse or ... utilization of resources, avoidable days/denials. Works in collaboration with Appeals Management/Medical Director in the appeals process....+ Current and valid license to practice as a Registered Nurse or Licensed Practical Nurse… more
- CVS Health (Tallahassee, FL)
- …licensure in non-compact states as needed. + 5+ years of acute experience as a Registered Nurse + 3+ years of Utilization Management experience + 3+ year(s) of ... 1993. We provide flexible, cost-effective care management solutions that promote high- quality healthcare for members. **Position Summary** The Associate Manager is… more