- Elevance Health (FL)
- **Appeals Nurse Reviewer I** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, ... clinical domains, including radiology, cardiology and oncology. The **Appeals Nurse Reviewer I** is responsible for conducting...Outreach to providers with appeal process instructions. + Clinical review for the RBM and Surgical solution on a… more
- AdventHealth (Orlando, FL)
- …collaboration with physicians, nursing and HIM coders, the Second Level Reviewer I strategically facilitates and obtains appropriate and quality physician ... complexity of care of the patient. The Second Level Reviewer I educates members of the patient care team...(ROM), and quality. + Completes accurate and timely record review to ensure the integrity of documentation compliance. +… more
- Centers Plan for Healthy Living (Margate, FL)
- …For Healthy Living is currently accepting applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works ... their home to improve their quality of life. Utilization Management Clinical Reviewer will assess and process all authorization requests to determine medical… more
- Zelis (FL)
- …interests that shape who you are. Position Overview The Inpatient DRG Reviewer will be primarily responsible for conducting post-service, pre-payment and post pay ... AHA Coding Clinic and client specific coverage policies. Conduct prompt claim review to support internal inventory management to achieve greatest savings for… more
- Actalent (Sunrise, FL)
- Job Title: Behavioral Health Utilization Review NurseJob Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing requests for ... with the interdisciplinary team, the UMN handles tasks related to utilization review across various specialties, medical treatments, and services. The role involves… more
- Centene Corporation (Tallahassee, FL)
- …Reside in Florida!** **Centene is Hiring!** **We're looking for a Remote Concurrent Review Nurse to support our Medicaid team.** **Ideal Candidate:** + **Has ... acute care bedside nursing experience** + **Brings a background in Utilization Management/ Review ** + **Holds an active nursing license** + **Is available to work… more
- Zelis (St. Petersburg, FL)
- …Effective and proven leadership experience is a must as recommendations to the Nurse Reviewer 's regarding their claim management is required. Additionally, this ... you are. Position Overview The Sr. Supervisor, Clinical Chart Review is focused on supervising a team of Clinician's...as needed Quality Assurance and complete bi-annual assessment of Nurse Reviewer performance. Report these results to… more
- Molina Healthcare (Tampa, FL)
- …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...quality of care issues. + Assists with Complex Claim review including DRG Validation, Itemized Bill Review ,… more
- Actalent (Sunrise, FL)
- …+ Deliver telephonic and digital outreach to engage members in care management programs. + Educate members on dietary practices tailored to chronic conditions ... including anxiety, asthma, COPD, CHF, depression, and diabetes. + Develop and guide members through clinically indicated dietary plans to support self-management and treatment goals. + Collaborate with Community Resource Coordinators and market-level partners… more
- MyFlorida (Land O' Lakes, FL)
- SENIOR LICENSED PRACTICAL NURSE - 50000083 Date: Sep 26, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... Requisition No: 853668 Agency: Veterans Affairs Working Title: SENIOR LICENSED PRACTICAL NURSE - 50000083 Pay Plan: Career Service Position Number: 50000083 Salary:… more