- University of Miami (Medley, FL)
- …III to work remotely. Under the general direction of the Inpatient Coding Manager , the Inpatient Coder III reviews documentation in the electronic medical record ... validation and physician query workflow. + Analyze and sequence codes in compliance with ICD-10 official coding guidelines, Uniform Hospital Discharge Data Set… more
- Humana (Tallahassee, FL)
- …comprehensive test plans + Ongoing Medicaid pricer maintenance, quality assurance, and compliance + Determining root causes driving issues and developing solutions + ... researching and resolving provider reimbursement inquiries + Experience with Optum Rate Manager + Experience with Optum WebStrat or PSI applications + Experience… more
- Humana (Tallahassee, FL)
- …campus and datacenters. The primary responsibility of the Network Operations Manager will be to provide the highest quality network infrastructure environment ... for future budget forecasting and planning needs. + Communicate status updates to Manager of IT and other Senior business leaders where necessary. + Research and… more
- Humana (Tallahassee, FL)
- …with our Security Automation Product Owner, Product Security Product Manager , Product Security Governance, DevOps, Enterprise Information Protection and Enterprise ... Information Systems Security Professional * (CISSP), Certified Information Security Manager (CISM), Certified Information Systems Auditor (CISA) or other similar… more
- Humana (Tallahassee, FL)
- …largest providers of home health services, and fourth largest pharmacy benefit manager , CenterWell is focused on whole-person health by addressing the physical, ... questions on financials and operations + Provide financial insights for long -term strategic decision-making across the broader CW segment + Support prioritization… more
- Molina Healthcare (Tampa, FL)
- …appropriate and correct clinical decisions for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) ... on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long -Term Services & Supports issues. + Identifies and reports quality of… more
- CenterWell (Orlando, FL)
- …license. + Must have strong knowledge of governmental regulations, Medicare eligibility requirements, comprehensive understanding of potential care plan needs ... volunteer time off, paid parental and caregiver leave), short-term and long -term disability, life insurance and many other opportunities. **About Us** About… more
- Actalent (Sunrise, FL)
- …utilization. Working under the general supervision of the Director and/or Manager /Supervisor of Medical Management, and in collaboration with an interdisciplinary ... Director/Physicians for requests outside standard Review Criteria. + Maintain compliance with federal, state guidelines, and contractual requirements. + Obtain… more
- CenterWell (Tallahassee, FL)
- …+ Previous experience with pharmacy benefits management + Previous Commercial, Medicare and/or Medicaid experience + Previous clinical experience in managed care ... volunteer time off, paid parental and caregiver leave), short-term and long -term disability, life insurance and many other opportunities. **About us** About… more
- CenterWell (Tamarac, FL)
- …as a Referral Coordinator, in a clinical setting, preferably within the Medicare population** + **MUST be Bilingual English/Spanish** + Proficient with Microsoft ... volunteer time off, paid parental and caregiver leave), short-term and long -term disability, life insurance and many other opportunities. **About Us** About… more