- Molina Healthcare (Orlando, 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
- 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
- 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 (Orlando, 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
- Molina Healthcare (Orlando, FL)
- …retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees as required such as ... Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial… more