- Molina Healthcare (Tampa, FL)
- …unrestricted Certified Clinical Coder + Certified Medical Audit Specialist + Certified Case Manager + Certified Professional Healthcare Management + Certified ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct clinical decisions for appeals outcomes within compliance… more
- Elevance Health (Vero Beach, FL)
- …+ Assists and participates in appeal or fair hearings, member grievances, appeals , and state audits. **Minimum Requirements:** + Requires BA/BS degree and a ... field preferred. + Bilingual in English/ Spanish strongly preferred. + LTSS, case management, social work or hospital discharge planning experience preferred. Please… more
- Cardinal Health (Tallahassee, FL)
- …insurance plan coverage, including out-of-pocket costs, and provide guidance on the appeals process if needed + Resolve patient's questions and any representative ... for the patient's concerns regarding status of their request for assistance + Demonstrate expertise in payer landscapes and insurance processes. Remain knowledgeable about long and short-range changes in the reimbursement environment including Medicare,… more
- CHS (Clearwater, FL)
- **Overview** **Claims Manager ** **Servicing** **Health Insurance Policies or Benefits** **Summary:** Premier Administrative Solutions (PAS) is a Third-Party ... the client's stated coverage. Join Premier Administrative Solutions as a Claims Manager and lead our Claims Department in delivering exceptional service to insurance… more
- MyFlorida (Tallahassee, FL)
- CITIZEN SERVICES OPERATIONS MANAGER - 41001114 Date: Aug 21, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify ... Agency: Office of the Attorney General Working Title: CITIZEN SERVICES OPERATIONS MANAGER - 41001114 Pay Plan: SES Position Number: 41001114 Salary: $44,028.79… more
- Ralliant (Tallahassee, FL)
- **Job Title:** Product Manager **Location:** Remote, USA **Job Summary:** As a key contributor within Hengstler-Dynapar, the **Product Manager ** will guide the ... aligns with the company's business objectives while collaborating cross-functionally. The Product Manager will work closely with all functions within our company to… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …information. Preferred: + Bachelor's or master's degree in nursing (BSN/MSN) + Certified Case Manager (CCM) or similar certification + Fluent in Spanish ... guidelines and insurance coverage. + Provide telephonic and/or in-person case management and member education regarding conditions, medications, and treatment… more
- Elevance Health (Miami, FL)
- …director provides clinical expertise in all aspects of utilization review and case management. Provides input on the clinical relevance to account reporting ... medical director is directly involved in Utilization Management and Case Management. + Daily case reviews for...the United States when conducting utilization review or an appeals consideration and cannot be located on a US… more
- Prime Therapeutics (Tallahassee, FL)
- …an office or home setting for drug services. + Will actively maintain a required case load and the activities to reach overall goals of switching site of service ... and spreadsheets. + Supports clinical services such as the appeals program. + Participates in meetings and consults with...is valued with the program. + Maintains an active case load and accurate case records, adhering… more
- Audacy (Orlando, FL)
- …Title: Promotions Assistant** **Department: Promotions** **Reporting To: Promotions** ** Manager ** **Employment Type:** **Part Time** **Work Arrangement:** **Hybrid** ... Orlando. While it is "Orlando's Home For Throwbacks" it's brand transcends generations and appeals to listeners from all walks of life. As such, we are looking for… more
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