- Elevance Health (Tampa, FL)
- ** Nurse Appeals - Medicare ** **Location:** Virtual: This role enables associates to work virtually full-time, with the exception of required in-person ... some shifts from Tuesday to Saturday and coverage on certain holidays. The ** Nurse Appeals - Medicare ** is responsible for investigating and processing and… more
- Molina Healthcare (Orlando, FL)
- …appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical decisions for … more
- Molina Healthcare (FL)
- …medical necessity. + Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the investigation of adverse ... medical director, and quality improvement staff. + Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews quality referred… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- Onsite Position Position Purpose: Works in partnership with physicians, nurse case managers, and other disciplines to ensure the appropriateness for the ... in utilization of resources, avoidable days/denials. Works in collaboration with Appeals Management/Medical Director in the appeals process. + Responsible… more