Medical Appeals Jobs (NOW HIRING)

Requisition No: 881526 

Agency: Management Services

Working Title: LEGAL NURSE COORDINATOR - 72002680

 Pay Plan: Career Service

Position Number: 72002680 

Salary:  $70,000 - $72,000 

Posting Closing Date: 08/25/2026 

Total Compensation Estimator Tool

Legal Nurse Coordinator
Division of State Group Insurance
State of Florida Department of Management Services
This is an on-site position located in Tallahassee, FL

Position Overview and Responsibilities:

The Department is seeking a highly motivated professional to serve as a Legal Nurse Coordinator. This position serves as the primary point of contact for reviewing and providing determinations of the division’s medical claims issues and the appeals process. The incumbent will be responsible for conducting all medical research and providing expert testimony for all level II medical appeals. This position is critical to ensure that the level II medical appeals are handled by an individual with the appropriate educational background. The level of direct member and customer service support provided requires the incumbent to possess a thorough knowledge and understanding of the laws, rules, policies, and procedures governing state benefit programs, as well as the People First system and operational procedures. This position is also critical to ensure that all program members receive world-class customer service. The duties of this position require a high degree of confidentiality, accuracy, and adherence to timeframes.

Responsibilities of this position will include, but not be limited to:

Appeals Management/Coordination:

a.    Research Level II medical appeals and prepares agency action letters for approval by the division director.
b.    Research claim disputes and issues benefit determination letters in accordance with applicable rules and benefit provisions.
c.    Provides testimony for administrative hearings and judicial court cases.
d.    Responds to routine requests for information and explains policies, procedures and program information to eligible members; uses available resources (plan documents and websites) to educate members about covered services and benefits.
e.    Recommends improved procedures to submit and review medical claims and to streamline operational processes with third-party plan administrators. 
f.    Establishes, maintains and revises standard operating procedures as needed.
g.    Provides input to improve language in plan documents, the MyBenefits website, benefits guide, etc.

Medical Coordination:

a.    Research and coordinates proposed wellness benefits and incentives.
b.    Recommend strategies for improved member participation.
c.    Serve as a medical resource for the Division.
d.    Research and identify wellness benefits and incentives that have provided the greatest ROI of other State government insurance plans.
e.    Identify long-term and short-term goals and processes to positively impact our health care plans.
f.    Act as a liaison between the division’s health care and pharmacy providers to increase healthy behaviors and decrease morbidity and mortality among our members.
g.    Represents the Division at professional meetings and conferences and may be required to prepare and deliver presentations.

Other Duties:  

Provides cross-functional support to the Clinical Consultant and other DSGI work units for special projects and peak workload periods as required to support the Division’s operational needs.  Provides prompt, professional and courteous customer service in response to all inquiries and requests for information received by DSGI.

Knowledge, Skills, and Abilities:

•    Knowledge of the State Employees’ PPO Plan, HMO plans and the Prescription Drug Plan.
•    Outstanding oral and written communication abilities.
•    Understanding of clinical practices and procedures, medical records.
•    Knowledge of major medical insurance plan practices.
•    Ability to research and compile information and data from a variety of online and other sources.
•    Excellent public speaking skills.
•    Familiarity with legal proceedings.
•    Knowledge of state laws, rules, policies and procedures governing the State Group Insurance Program.
•    Knowledge of federal laws and regulations governing or affecting pretax benefit programs, including IRC Section 125, COBRA, Medicare, HIPAA, etc.
•    Ability to work independently.
•    Ability to establish and maintain effective working relationships with others.
•    Knowledge of People First procedures and system.
•    Proficient in Microsoft Office suite.
•    Outstanding customer service skills. 
•    Accountability, Communication, Teamwork, Empowerment, Flexibility, Integrity, Respect, Teamwork.

Minimum Qualifications:

•    Registered Nurse, currently licensed in Florida.
•    Three years of professional nursing experience.
•    Proficiency in Microsoft Office, Word, and Excel.

Our Organization and Mission:
Under the direction of Governor Ron DeSantis, Secretary Tom Berger and DMS’ Executive Leadership Team, the Florida Department of Management Services (DMS) is a customer-oriented agency with a broad portfolio that includes the efficient use and management of real estate, procurement, human resources, group insurance, retirement, telecommunications, fleet, and federal property assistance programs used throughout Florida’s state government. It is against this backdrop that DMS strives to demonstrate its motto, “We serve those who serve Florida.”

Special Notes:
DMS is committed to successfully recruiting and onboarding talented and skilled individuals into its workforce. We recognize the extensive training, experience, and transferable skills that veterans and individuals with disabilities bring to the workforce. Veterans and individuals with disabilities are encouraged to contact our agency recruiter for guidance and answers to questions through the following provided email addresses: 
DMS.Ability@dms.fl.gov
DMS.Veterans@dms.fl.gov.
An individual with a disability is qualified if he or she satisfies the skills, experience, and other job-related requirements for a position and can perform the essential functions of the position with or without reasonable accommodation. For purposes of requesting reasonable accommodations, as mentioned above, the agency hiring authority is the DMS Human Resources office, which the candidate can reach at (850) 488-2707.
Successful completion of background screening will be required for this position.

Candidates requiring a reasonable accommodation, as defined by the Americans with Disabilities Act, must notify the agency hiring authority and/or People First Service Center (1-866-663-4735). Notification to the hiring authority must be made in advance to allow sufficient time to provide the accommodation.

The State of Florida supports a Drug-Free workplace. All employees are subject to reasonable suspicion drug testing in accordance with Section 112.0455, F.S., Drug-Free Workplace Act.

VETERANS’ PREFERENCE.  Pursuant to Chapter 295, Florida Statutes, candidates eligible for Veterans’ Preference will receive preference in employment for Career Service vacancies and are encouraged to apply.  Certain service members may be eligible to receive waivers for postsecondary educational requirements.  Candidates claiming Veterans’ Preference must attach supporting documentation with each submission that includes character of service (for example, DD Form 214 Member Copy #4) along with any other documentation as required by Rule 55A-7, Florida Administrative Code.  Veterans’ Preference documentation requirements are available by clicking here.  All documentation is due by the close of the vacancy announcement.