- Molina Healthcare (Jacksonville, FL)
- …to provide quality and cost-effective member care. This position will be supporting our Appeals and Grievances department. We are seeking a Registered Nurse with ... The Medical Review Nurse provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory… more
- Molina Healthcare (Jacksonville, FL)
- …reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * ... medical necessity. * Participates in and maintains the integrity of the appeals process, both internally and externally. * Responsible for investigation of adverse… more
- J&J Family of Companies (Jacksonville, FL)
- …eligibility and benefit verification, pre-authorization, billing, coding, claims, and appeals / grievances ); REMs certification; Medicare and Medicaid rules and ... * Interviews with the team: If you move forward, you'll meet with the hiring manager (and possibly others on the team) in one or two interview rounds, depending on… more