- Molina Healthcare (St. Petersburg, FL)
- …Services (CMS), policies and procedures, quick reference guides (QRGs), audit tools and additional requirements during implementations. Attends all implementation ... setting, or equivalent combination of relevant education and experience. * Registered Nurse (RN), Licensed Social Worker (LSW), or Licensed Independent Social Worker… more
- MTC (Quincy, FL)
- …to determine all provided services are documented. 14. Closely monitor illnesses. 15. Audit pharmacy use for adherence to formulary and compliance with all pharmacy ... nursing experience with one (1) year supervisory experience. Must be a licensed registered nurse in the state of Florida or compact state. Must possess current CPR… more
- Prime Therapeutics (Tallahassee, FL)
- …Program Integrity Audits including outreach and review of medical records to audit authenticity of provider response during Prior Authorization and reporting results ... their staff, cardholders, and pharmacies. + Escalates medical exception requests to nurse , pharmacist or physician on the utilization review clinical team when… more
- Zelis (St. Petersburg, FL)
- …Zelis standards regarding privacy What you'll bring to Zelis: + Registered Nurse licensure preferred + Inpatient Coding Certification required (ie, CCS, CIC, RHIA, ... CM, MS-DRG and APR-DRG claims preferred + Solid understanding of audit techniques, identification of revenue opportunities and financial negotiation with providers… more
- Elevance Health (Tampa, FL)
- …as appropriate regarding approved interventions such as recovery of overpayment, pre-payment audit of claims or putting providers on notice. + Assists with training ... **Preferred Skills, Capabilities, and Experiences:** + Coding Certificate or Registered Nurse strongly preferred + Law Enforcement dealing with Healthcare Fraud… more
- YesCare Corp (Punta Gorda, FL)
- …rotating on call.** + **Rate: 58.20** + Active license, if applicable. + **Registered Nurse required in lieu of degree.** + **Minimum of three (3) years of ... with allYesCareand applicable client systems and applications. + Coordinates the Medical Audit Committee and facilitates the monthly meetings. + Secure and Maintain… more
- ChenMed (Jacksonville, FL)
- …and other governing agencies. Enforces clinical and quality standards and internal audit requirements of ChenMed. + Completes all required training to dispense ... healthcare related field preferred + Active and good standing Licensed Practical Nurse (LPN) in current state of employment **OR** a nationally accredited Certified… more
- YesCare Corp (Tallahassee, FL)
- …County in Tallahassee, FL** **Administrative** + Serve as Chairman of the Medical Audit Committee. + Consult with medical providers in the community to resolve ... of care and chart reviews as requested. Sponsors physician assistants or nurse practitioners as required. + Notifies Regional Medical Director and Site Health… more
- GE Vernova (Pensacola, FL)
- …are developed and implemented. + Own and manage the Wind Manufacturing audit program for the nacelle factories **Required Qualifications** + Bachelor's Degree from ... and prescription drug coverage; access to a Health Coach, a 24/7 nurse -based resource; and access to the Employee Assistance Program, providing 24/7 confidential… more
- AssistRx (Orlando, FL)
- …Previous call center experience participating in quality call and system audit performance reviews preferred. + Previous experience in patient support/patient ... access programs preferred. + Bilingual - Spanish preferred. + Bachelor's Degree or Registered Nurse (BSN or RN) a plus. + COMPETENCIES: + Adaptability - Adapts to… more