• Medical Claim Review

    Molina Healthcare (Tampa, FL)
    …Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in ... more
    Molina Healthcare (01/25/25)
    - Save Job - Related Jobs - Block Source
  • Diagnosis Related Group Clinical Validation…

    Elevance Health (Tampa, FL)
    …experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing ... more
    Elevance Health (01/01/25)
    - Save Job - Related Jobs - Block Source
  • Clinical Appeals Nurse (RN): Texas and New…

    Molina Healthcare (Tampa, FL)
    …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... more
    Molina Healthcare (02/09/25)
    - Save Job - Related Jobs - Block Source
  • Telephonic Nurse Case Manager II

    Elevance Health (Tampa, FL)
    **Telephonic Nurse Case Manager II** **Location: This is a virtual position. Candidates must reside within 50 miles of an Elevance Health Pulse Point location.** ... more
    Elevance Health (02/13/25)
    - Save Job - Related Jobs - Block Source
  • Medical Director (Medicare)

    Molina Healthcare (Tampa, FL)
    …retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees as required such as ... more
    Molina Healthcare (02/09/25)
    - Save Job - Related Jobs - Block Source
  • Medical Director (Marketplace)

    Molina Healthcare (Tampa, FL)
    …retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees as required such as ... more
    Molina Healthcare (02/06/25)
    - Save Job - Related Jobs - Block Source
  • Utilization Management Representative II

    Elevance Health (Tampa, FL)
    …Finder and follows up with provider on referrals given. + Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care. + ... more
    Elevance Health (02/15/25)
    - Save Job - Related Jobs - Block Source
  • Utilization Management Representative I

    Elevance Health (Tampa, FL)
    …prior authorization, and post service requests. + Refer cases requiring clinical review to a Nurse reviewer. + Responsible for the identification ... more
    Elevance Health (02/07/25)
    - Save Job - Related Jobs - Block Source