- Molina Healthcare (Orlando, FL)
- …Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in ... **Job Duties** + Performs clinical/ medical reviews of retrospective medical claim reviews, medical claims and previously denied cases, in which… more
- MyFlorida (Orlando, FL)
- …that all verbal orders, including telephone orders from attending physicians, are reviewed by a registered nurse . + If no RN is available, receive all ... reflective of resident's status, and providing supervision and guidance to the Registered ( RN ), Licensed Practical Nurse (LPN), Certified Nursing… more
- Public Consulting Group (Tallahassee, FL)
- …sector. To learn more, visit www.publicconsultinggroup.com . PCG is currently seeking a qualified Registered Nurse to perform as a Case Manager. The Case Manager ... Proven working experience in case management, including as a nurse , medical , mental health care manager or...plans. + Current license, certification or registration as a Registered Nurse or Social Worker **Working Conditions**… more
- Molina Healthcare (FL)
- …to health care fraud, waste, and abuse. Duties include performing accurate and reliable medical review audits that may also include coding and billing reviews. ... nursing experience with broad clinical knowledge. + Five years experience conducting medical review and coding/billing audits involving professional and facility… more
- AdventHealth (Altamonte Springs, FL)
- …: Remote **The role you will contribute:** The role of the Utilization Management (UM) Registered Nurse ( RN ) is to use clinical expertise by analyzing ... resolutions of conflicts between status and authorization. Evaluates clinical review (s) and physician documentation for at-risk claims ;.... Current and valid license to practice as a Registered Nurse (ADN or BSN) required. .… more
- Molina Healthcare (Orlando, FL)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical/ medical reviews of… more
- Guardian Life (Tallahassee, FL)
- …providing comprehensive medical reviews and analysis of long-term disability claims . The RN Clinical Consultant identifies restrictions, limitations and ... duration impacting functional capacity based on medical data, to assist the Claim Managers...The RN Clinical Consultant reviews long-term disability claims to determine the impact of claimants' medical… more
- MetLife (Tampa, FL)
- …quarterly meetings with the Vocational resource and Account team member. * Participate in claim review meetings as requested by the customer. * Utilize tools ... for meetings Key Responsibilities: * Independently assess, analyze and render appropriate claim decisions pursuant to certificates on all claims . * Compare… more
- AdventHealth (Altamonte Springs, FL)
- …expertise and experiences you'll need to succeed:** . Bachelor's . 1 Related Experience . Registered Nurse ( RN ) . Extensive understanding of CPT, HCPCS, ICD, ... Outpatient clinical services across the system, as well as review and correct charge errors. The ability to effectively...strategic focus. + Able to defend and appeal denied claims via both written and verbal communication in clear… more
- Lincoln Financial (Tallahassee, FL)
- …as indicated **What we're looking for** * 4 Year/Bachelor's Degree in Nursing * Registered Nurse License - Current, unrestricted license in the state where the ... organization. This position will be responsible for reviewing, analyzing, and interpreting medical information available for disability claims . In this role you… more