- Humana (Miramar, FL)
- …Specialist 1 handles the delivery, setup, and comprehensive explanation of various medical equipment in patients' homes. This role requires not only training ... in a comprehensive multiweek training program focused on the basics of medical equipment setup, cleaning, and testing. This foundational role is essential for… more
- CVS Health (Hollywood, FL)
- …our Dual Eligible Special Needs Plan (DSNP) members, who are enrolled in both Medicare and Medicaid and face a variety of complex health and social challenges. ... + Conducting field visits to the member's home, community locations, medical facilities, and other locations. + Completing care management focused assessments.… more
- CenterWell (The Villages, FL)
- …years of hands-on healthcare experience in a clinical setting, preferably within the Medicare population + Proficient with medical terminology + Proficient with ... including Microsoft Word, Excel and Outlook + Experience with Electronic Medical Records + Excellent professional communication abilities, at all levels within… more
- Actalent (Sunrise, FL)
- … Medical Director/Physicians for requests outside standard Review Criteria. + Maintain compliance with federal and state guidelines as well as contractual ... Utilization management + InterQual + Milliman Commercial Guidelines + Medicaid + Medical management + Medicare + Managed care + Patient care + Medical record… more
- Molina Healthcare (Tampa, FL)
- …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 cases in which a...advanced clinical knowledge, knowledge of all relevant and applicable Federal and State regulatory requirements and guidelines, knowledge of… more
- Elevance Health (FL)
- …vendor. + Manages and coordinates the development, approval, implementation and compliance of on-going external client facing programs. + Develops program budget. ... Project management certification preferred. + Marketing experience preferred. + Medicare Part D experience preferred. + Fraud waste and...of gender, race, or any other category protected by federal , state, and local pay equity laws _._ *… more
- CenterWell (Orlando, FL)
- …a wide range of people including physicians, office staff, hospital executives, medical groups, IPA's, community organizations and other health plan staff + ... of and experience working with Provider Communities + Experience with Electronic Medical Record (EMRs) or Health Information Management (HIMs) systems + Knowledge of… more
- CenterWell (Casselberry, FL)
- …a wide range of people including physicians, office staff, hospital executives, medical groups, IPA's, community organizations and other health plan staff + ... of and experience working with Provider Communities + Experience with Electronic Medical Record (EMRs) or Health Information Management (HIMs) systems + Knowledge of… more
- Humana (Stuart, FL)
- …information, developing and conducting in-service training programs. + Complies with federal , state, and local legal and certification requirements by studying ... your skills to make an impact** **Required Qualifications** + Complies with federal , state, and local legal and certification requirements by studying existing and… more
- Humana (Tallahassee, FL)
- …and deadlines with diligence. + Ability to understand state and regulatory compliance . **Use your skills to make an impact** **Required Qualifications** + Minimum ... Excel, PowerPoint, and Lucid. **Preferred Qualifications** + Minimum 1 year of experience medical claims payment and processing in a medical claim's environment… more