- Molina Healthcare (Miami, FL)
- JOB DESCRIPTION **Job Summary** The Medical Claim Review Nurse provides support for medical claim review activities. Responsible for ensuring ... hospital setting, including at least 1 year of utilization review , medical claims review...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
- Molina Healthcare (Miami, FL)
- …work on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing clinical knowledge and ... Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in … more
- Carnival Cruise Line (Miami, FL)
- …health team to assess fitness for duty per International Maritime Health guidelines. + **Crew Medical Claims Management** + Review crew cases of high risk ... return-to-work planning in compliance with regulations and employment obligations. + Support disability claims and benefits review for crew unable to return to… more
- Molina Healthcare (Miami, FL)
- …Microsoft Excel (edit/save spreadsheets, sort/filter) **Required License, Certification, Association** Licensed registered nurse ( RN ), Licensed practical ... internal policies, and contract requirements. This position completes a medical review to facilitate a referral to...corresponding medical records to determine accuracy of claims payments. + Review of applicable policies,… more
- Sedgwick (Miami, 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 are made on claims .… more
- Aveanna Healthcare (Miami, FL)
- Home Health RN Clinical Director of Operations 10k Sign On Bonus ApplyRefer a FriendBack Job Details Requisition #: 208380 Location: Miami, FL 33166 Category: ... Management/Issue Resolution * Plan and implement branch growth strategies * Thorough review of financial statements, activity reports, and other performance data to… more
- Sedgwick (Miami, FL)
- …the ADA process for claimants requesting accommodations under the ADAAA; to review complex medical information for temporary and permanent accommodation ... and/or client requirements. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Reviews medical information for ADAAA temporary and permanent accommodation requests. +… more
- Sedgwick (Miami, FL)
- …the ADA process for claimants requesting accommodations under the ADAAA; to review complex medical information for temporary and permanent accommodation ... are driven to deliver great work. + Apply your medical /clinical or rehabilitation knowledge and experience to assist in...one of the following licenses or certifications is required: RN or CRC. **TAKING CARE OF YOU BY** +… more
- MyFlorida (Miami, 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
- University of Miami (Miami, FL)
- …potentially compensable events to Chief Medical Risk Officer, Director of Medical Claims and Assistant General Counsel. Conduct additional investigation and ... + Minimum 5 years of relevant experience required, 7-10 years' experience preferred + Medical /Legal background is a plus + RN Training and licensure is a… more
- University of Miami (Miami, FL)
- …potentially compensable events to Chief Medical Risk Officer, Director of Medical Claims and Assistant General Counsel. + Conduct additional investigation ... Degree in relevant field required + Minimum 5 years of relevant experience required + Medical /Legal background is a plus + RN Training and licensure is a plus… more
- Elevance Health (Miami, 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
- Elevance Health (Miami, FL)
- **Telephonic Nurse Case Manager II** **Location** : This role enables associates to work virtually full-time, with the exception of required in-person training ... different states; therefore Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager II** is responsible for performing care management within… more
- Elevance Health (Miami, FL)
- **Telephonic Nurse Case Manager Senior** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training ... in different states; therefore, Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager Senior** is responsible for care management within the… more
- Elevance Health (Miami, 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