- USAA (Tampa, FL)
- …to include 6 years of experience working as a Registered Nurse ( RN ), Nurse Practitioner (NP), or Medical Doctor (MD) with accountability for highly ... us special and impactful. **The Opportunity** USAA Life Company's Claim Team is seeking a talented ** Medical ...+ Expert Advice: Ability to review complicated medical records and medical claims ,… more
- Molina Healthcare (St. Petersburg, 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
- Molina Healthcare (St. Petersburg, 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
- 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
- Elevance Health (Tampa, FL)
- …and efficiency recommendations. **Minimum Requirements:** + Requires current, active, unrestricted Registered Nurse license in applicable state(s). + Requires a ... experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing… more
- Elevance Health (Tampa, FL)
- …enforcement referral, and use of proprietary data and claim systems for review of facility, professional and pharmacy claims . + Responsible for independently ... Integrity, is determined to recover, eliminate and prevent unnecessary medical -expense spending. The **Investigator Senior** is responsible for the independent… more
- MyFlorida (Tampa, FL)
- …examination by a licensed physician, physician assistant, or licensed advanced practice registered nurse , based on specifications established by the commission. ... but are not limited to fraud against the Medicaid Program, false claims against the Medicaid program, investigating possible criminal violations of any applicable… 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