- Evolent (Tallahassee, FL)
- …ensuring accurate and timely ICD-10 coding of claims via progress note clinical documentation review . + Ensure compliance and quality for all coding ... Evolent for the mission. Stay for the culture. **What You'll Be Doing:** ** Manager , Coding Support Specialist** Evolent Care Partners is seeking a Risk Adjustment… more
- HCA Healthcare (Atlantis, FL)
- …and personal growth, we encourage you to apply for our Senior Risk Manager opening. We promptly review all applications. Highly qualified candidates will ... you have the career opportunities as a(an) Senior Risk Manager you want with your current employer? We have...Summary and Qualifications** Responsible for the operation of the clinical risk and patient safety program on a day-to-day… more
- Zelis (St. Petersburg, FL)
- …you are. Position Overview The Manager , DRG Validation of the Expert Claims Review (ECR) department is responsible for daily operations and team management ... of the DRG product. The Manager , DRG Validation will be primarily responsible for the...industry standard inpatient coding guidelines and rules, evidence based clinical criteria, and policy exclusions. Focus will be on… more
- CVS Health (Tallahassee, FL)
- …enhance a member's overall wellness through integration. - Through the use of clinical tools and information/data review , conducts an evaluation of member's ... heart, each and every day. **Position Summary:** This Case Manager RN position is with Aetna's National Medical Excellence...smooth transition to Aetna programs and plans. - Applies clinical judgment to the incorporation of strategies designed to… more
- Sumitomo Pharma (Tallahassee, FL)
- …regulatory submissions by preparing responses to agency inquiries and contributing to labeling claims . + Review Case Report Forms (CRFs) to ensure data ... highly motivated, and experienced individual for the position of Manager of Biostatistics to serve as trial statistician for...to serve as trial statistician for one or more clinical studies. He or she works closely with the… more
- Walgreens (Orlando, FL)
- …rejections. Resolves third-party rejection problems promptly and resubmits rejected claims for payment promptly. + Manages and controls Prescription Department ... and various government agencies. Business Planning + Works with the Registered Manager , Local Specialty Pharmacy to solicit third party prescription business and… more
- Elevance Health (Miami, FL)
- **Telephonic Nurse Case Manager II** **Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... receipt and meet the criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management within the...as applicable. + Assists in problem solving with providers, claims or service issues. + Assists with development of… more
- Public Consulting Group (Tallahassee, FL)
- …Third Party Administrator Services + Enhance Health and Public Safety Services + Claims Processing Services and Solutions + Consulting and Advisory Services + Cost ... efficient, equitable, and client-centered + Handles case assignments, draft service plans, review case progress and determine case closure + Travels within the State… more
- Elevance Health (Tampa, FL)
- …submitted DRG. **How you will make an impact:** + Analyzes and audits claims by integrating medical chart coding principles, clinical guidelines and objectivity ... is responsible for auditing inpatient medical records and generating high quality recoverable claims for the benefit of the company, for all lines of business, and… more
- Elevance Health (Miami, FL)
- …determination. + Responsibilities exclude conducting any utilization or medical management review activities which require the interpretation of clinical ... party) and multiple products (ie HMO, POS, PPO, EPO, CDHP, and indemnity) related to clinical and non clinical services, quality of service, and quality of care… more