- 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
- Lincoln Financial (Tallahassee, FL)
- …for conducting initial and ongoing interviews with claimants, obtaining, and reviewing medical records and making timely and ethical claim determinations. You'll ... through phone and e-mail to gather information regarding the Short Term Disability claim . + Collaborating with fellow case managers, nurse case managers and… more
- Lincoln Financial (Tallahassee, FL)
- …organization. This position will be responsible for reviewing, analyzing, and interpreting medical information available for disability claims . In this role you ... will act as a clinical resource for Group Protection benefit specialists and claim professionals. You will evaluate medical information to clarify diagnoses,… more
- AdventHealth (Riverview, FL)
- …be caring for:** AdventHealth Riverview AdventHealth is expanding our medical expertise, innovation, and state-of-the-art technology to southern Hillsborough County ... million project in Riverview also includes a 100,000 square foot, four-story Medical Office Building that will provide community members convenient access to expert… more
- Zelis (St. Petersburg, FL)
- …in an advisory role with management of direct reports required. + Advanced competency in medical claim review and payment integrity preferred. + Ability to ... a team of Clinician's performing clinical reviews of facility claims , including UB's, Itemized Bills and medical ...consistently. + Assess, track and report any delays in claim review or processing to the Manager,… more
- MyFlorida (St. Augustine, FL)
- SENIOR REGISTERED NURSE SUPV - 50950032 Date: Sep 16, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... . Requisition No: 858189 Agency: Veterans Affairs Working Title: SENIOR REGISTERED NURSE SUPV - 50950032 Pay Plan: Career Service Position Number: 50950032 Salary:… more
- MyFlorida (Orlando, FL)
- REGISTERED NURSE Date: Oct 4, 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
- CVS Health (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
- Cognizant (Tallahassee, FL)
- …. Draft and submit the medical necessity determinations to the Health Plan/ Medical Director based on the review of clinical documentation in accordance with ... to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work related to clinical… more
- AdventHealth (Daytona Beach, FL)
- …AdventHealth Daytona Beach **The community you'll be caring for:** 301 MEMORIAL MEDICAL PKWY, Daytona Beach, 32117 **The role you'll contribute:** The role of ... the Utilization Management (UM) Registered Nurse (RN) is to use clinical expertise by analyzing...to the Physician Advisor or designated leader for additional review as determined by department standards. Additionally, the UM… more
- Elevance Health (Tampa, FL)
- …and abuse prevention and control. + Review and conducts analysis of claims and medical records prior to payment. Researches new healthcare-related questions ... **Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU**...Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Clinical Fraud Investigator II** is responsible… more
- Elevance Health (Tampa, FL)
- **Telephonic RN Nurse Case Manager I** **Sign On Bonus: $3000** **Location: This role enables associates to work virtually full-time, with the exception of required ... in different states; therefore Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager I** is responsible for performing care management within… more
- Elevance Health (Tampa, FL)
- **Telephonic Nurse Case Manager II** **Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... hours of receipt and meet the criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management...management plan and modifies as necessary. + Interfaces with Medical Directors and Physician Advisors on the development of… more
- Sedgwick (Tallahassee, FL)
- …review process including making a recommendation of specialty for the Independent Medical Review process. + Developing and delivering training materials and ... Best Workplaces in Financial Services & Insurance Sr. VP Medical Director **PRIMARY PURPOSE** **:** To evaluate medical...the following: + Conducting reviews on cases where the nurse is seeking treatment plan clarification, claim … more
- Zelis (FL)
- …Guidelines, AHA Coding Clinic and client specific coverage policies. Conduct prompt claim review to support internal inventory management to achieve greatest ... plan, and policy exclusions. Conduct reviews on inpatient DRG claims as they compare with medical records...concepts to expand the DRG product. + Manage assigned claims and claim report, adhering to client… more
- Veterans Affairs, Veterans Health Administration (Miami, FL)
- …Orthotic Lab and/or supervisors in regard to completion of required reports or claims pertaining to state, federal, and medical center regulations, and policies ... range of medical clinicians across multiple disciplines (eg medical doctors, nurse practitioners, physician assistants, psychologists, psychiatrists, social… more
- ICW Group (Orlando, FL)
- …and vendors. + Acts as a gatekeeper for referrals between in-house telephonic nurse case managers, claims examiners and vendors. Reviews open referrals and ... goals and objectives. Provides cost containment program support. + Provides support to claims and audit teams as needed for medical management oversight results… more
- Veterans Affairs, Veterans Health Administration (Orlando, FL)
- …Extended Care. The Assistant Medical Director in collaboration with the HBPC Medical Director, HBPC Program Director and HBPC Nurse Manager are responsible ... VHA Education Loan Repayment Services program office after complete review of the EDRP application. VA offers a comprehensive...nurse practitioners. Serves as a consultant to other medical center staff and trainees. Represents the HBPC on… more
- Sedgwick (Tampa, FL)
- … review of referred claims ; documents decision rationale; and completes medical review of all claims to ensure information substantiates disability. ... + Provides clear and appropriate follow-up recommendations for ongoing medical management of claims ; ensures appropriate recommendations...change the duties of the position at any time. \# nurse Sedgwick is an Equal Opportunity Employer and a… more
- Herc Rentals (Bonita Springs, FL)
- …oversee. + Assist with additional or special projects as required by the business. + Review and submission of all warranty claims based on work orders received ... assistance beyond the stated warranty period or policy. Create claims from the work orders for those failures following...are not limited to the following. **Keeping you healthy** Medical , Dental, and Vision Coverage Life and disability insurance… more