- Molina Healthcare (St. Petersburg, FL)
- …retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees as required such as ... Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial… more
- Elevance Health (FL)
- …experience preferred. + Broad knowledge of clinical documentation improvement guidelines, medical claims billing and payment systems, provider billing ... the conditions and DRGs billed and reimbursed. Specializes in review of Diagnosis Related Group (DRG) paid claims...you will make an impact:** + Analyzes and audits claims by integrating medical chart coding principles,… more
- CVS Health (Tallahassee, FL)
- …issues. -Explains member's rights and responsibilities in accordance with contract. -Processes claim referrals, new claim handoffs, nurse reviews, complaints ... Law Document Center regarding litigation; lawsuits. -Handles extensive file review requests. **Responsibilities** + Answering questions and resolving issues based… more
- MyFlorida (Chattahoochee, FL)
- …a magnitude of daily resident incident reports in a priority manner. Review reports for timeliness, content, accuracy, and ensuring compliance with applicable ... Agency for Health Care Administration, Florida Department of Health, the Safe Medical Devices Act, CARF Accreditation, Children and Family Regulations. + Produce and… more
- Veterans Affairs, Veterans Health Administration (West Palm Beach, FL)
- Summary The West Palm Beach VA Medical Center is currently seeking a full-time Physician to join the West Palm Beach VA Medical Center Mental Health and ... performing that role, also currently performs the duties and responsibilities of the Medical Director of the Acute Inpatient Psychiatry Unit (3C). The 3C Medical… more
- Veterans Affairs, Veterans Health Administration (Lake City, FL)
- Summary The Malcom Randall VA Medical Center is currently seeking a full-time Physician to join the North Florida/South Georgia VA Medical Center Mental Health ... coordinates and directs comprehensive, interdisciplinary team of psychologist, psychiatrist, nurse , social worker, admin support staff, ensuring a smooth continuum… more
- Veterans Affairs, Veterans Health Administration (Lake City, FL)
- …care. Duties include, but are not limited to: Supervise and instruct Nurse Practitioners, Physician Assistants, Medical Students, Residents or Geriatric Fellows ... as needed in an Interdisciplinary Team setting. Collaborate with Nurse Practitioners/Physician Assistant, ancillary health care providers, and various clinical… more
- Elevance Health (Tampa, FL)
- …fraud and abuse prevention and control. + Review and conducts analysis of claims and medical records prior to payment. + Researches new healthcare related ... + Performs in-depth investigations on identified providers as warranted. + Examines claims for compliance with relevant billing and processing guidelines and to… more
- Veterans Affairs, Veterans Health Administration (Orlando, FL)
- …and team player who is adaptable to the needs of a growing medical center. Responsibilities This is an open continuous announcement that will remain open ... determined by the VHA Education Loan Repayment Services program office after complete review of the EDRP application VA offers a comprehensive total rewards package.… more
- Lee County Board of County Commissioners (Fort Myers, FL)
- …Lead the process for choosing consultants with the Procurement Department, review bids and qualifications, and interview shortlisted vendors. + Negotiations: ... as a liaison with local municipalities and third-party stakeholders. + Oversight: Review pay applications from consultants and contractors, and visit project sites… more