- Point32Health (FL)
- …(https://www.point32health.org/) . **Job Summary** Under the general direction of the Member Appeals and Grievance Supervisor the Appeals and Grievance Analyst ... the professional and compliant management and coordination of assigned member appeals and grievance (complaints) received by Point32Health. This individual works… more
- Molina Healthcare (Miami, FL)
- …hours** Must be able to rotate weekends and holidays** Must have Medicare Appeals and IRE experience** Responsible for reviewing and resolving member and provider ... + Responsible for the comprehensive research and resolution of the appeals , dispute, grievances, and/or complaints from Molina members, providers and related… more
- Molina Healthcare (Tampa, FL)
- **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical decisions for appeals outcomes within compliance ... standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied...reviews of previously denied cases in which a formal appeals request has been made or upon request by… more
- Molina Healthcare (FL)
- …systems and other available resources. + Assures timeliness and appropriateness of appeals according to state and federal and Molina Healthcare guidelines. + ... Determines appropriate language for letters and prepare responses to appeals and grievances. + Elevates appropriate appeals ...to appeals and grievances. + Elevates appropriate appeals to the Appeals Specialist. + Generates… more
- Elevance Health (Miami, FL)
- **Medical Director-Internal Medicine or Family Medicine Appeals ** **Location:** This role enables associates to work virtually full-time, with the exception of ... by law. The **Medical Director-Internal Medicine or Family Medicine Appeals ** is responsible for the review of appeals... Appeals ** is responsible for the review of appeals for physical health medical services, to ensure the… more
- Humana (Tallahassee, FL)
- …The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments involve moderately ... Medical Director's work includes computer based review of moderately complex to complex appeals for coverage for drugs using resources outlined above as well as… more
- CVS Health (Tallahassee, FL)
- …focus primarily on review appeal cases for denied medical services. This includes First Level Appeals / Second Level Appeals / Expedited Appeals / Appeal ... Hearings / Special Projects and Committee participation when needed. The Medical Director will provide clinical, coding, and reimbursement expertise as well as directing case management when necessary. The Medical Director will act as a business and clinical… more
- Humana (Tallahassee, FL)
- …Medical Director relies on medical background and reviews health claims and preservice appeals . The Corporate Medical Director works on problems of diverse scope and ... complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and… more
- Humana (Tallahassee, FL)
- …Director (CMD) relies on medical background to review health claims and preservice appeals . The Corporate Medical Director works on problems of diverse scope and ... complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions regarding the appropriateness and medical necessity of services provided by other healthcare professionals in compliance with coverage… more
- City of Coral Gables, FL (Coral Gables, FL)
- …by the State of Florida and the Miami-Dade County Board of Rules and Appeals as a Certified Building Official and licensed as a Certified Floodplain Manager (CFM), ... sixteen hour HVHZ training course approved by the Board of Rules and Appeals before certification; or (2)Possess a current Registered Architect license issued by the… more