- Molina Healthcare (Miami, 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
- 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 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
- 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...change the duties of the position at any time. \# nurse Sedgwick is an Equal Opportunity Employer and a… more
- Molina Healthcare (Miami, 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
- University of Miami (Miami, FL)
- …staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The ... with protocols and regulations. CORE JOB FUNCTIONS + Submits claims to insurance companies and follows up on outstanding...+ Recommends policy and procedural changes to management for review as needed. + Adheres to University and unit-level… more
- Elevance Health (Miami, FL)
- …prior authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification ... I** is responsible for coordinating cases for precertification and prior authorization review . **How you will make an impact:** + Managing incoming calls or… more
- MyFlorida (Fort Lauderdale, FL)
- …by a licensed physician, physician assistant, or licensed advanced practice registered nurse , based on specifications established by the commission. In order to be ... but are not limited to: fraud against the Medicaid Program, false claims against the Medicaid program, investigating possible criminal violations of any applicable… more