- 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 ... clinical/ medical reviews of retrospective medical claim reviews, medical claims and...Claims Auditing, Medical Necessity Review and Coding experience +… more
- MyFlorida (Orlando, FL)
- REGISTERED NURSE Date: Jan 22, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... . Requisition No: 845312 Agency: Veterans Affairs Working Title: REGISTERED NURSE Pay Plan: Career Service Position Number: 50009834 Salary: $66,414.40 Posting… more
- AdventHealth (Altamonte Springs, FL)
- …for resolutions of conflicts between status and authorization. Evaluates clinical review (s) and physician documentation for at-risk claims ; performs additional ... reviews and/or include pertinent addendums to fortify/reinforce basis for accurate claim reimbursement. Demonstrates a strong understanding of medical necessity… more
- Molina Healthcare (Orlando, FL)
- … claims with corresponding medical records to determine accuracy of claims payments. + Review of applicable policies, CPT guidelines, and provider ... policies, CPT guidelines, internal policies, and contract requirements. This position completes a medical review to facilitate a referral to law enforcement or… 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