- Sedgwick (Tallahassee, FL)
- …PURPOSE OF THE ROLE:** While partnering with the injured worker, employer, and medical providers, create a case management strategy to facilitate medical ... and a successful return to work through advocacy, communication and coordination of medical services. **ARE YOU AN IDEAL CANDIDATE?** We are looking for enthusiastic… more
- CVS Health (Tallahassee, FL)
- …Provide excellent customer services for high volume inbound provider calls for the Claims Inquiry/ Claims Research Medicaid team. Extensive claims research on ... in accordance with contract. + Process claim referrals, new claim handoffs, nurse reviews, provider complaints, grievance and appeals via target system. + Assists… more
- Centene Corporation (Spring Hill, FL)
- …(NCQA) HEDIS measures. Provides education for HEDIS measures, appropriate medical record documentation and appropriate coding. Assists in resolving deficiencies ... community physician and small provider practices in appropriate HEDIS measures, medical record documentation guidelines and HEDIS ICD-9/10 CPT coding in accordance… more
- Sedgwick (Tampa, FL)
- …confirming delivery of said goods or service. + Communicates with vendor partners, claims adjusters and nurse case managers providing updates on new referrals ... to our clients and patients through processing referrals in the delivery of medical goods and services. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Reaches out to… more
- Sedgwick (West Palm Beach, FL)
- …Field Case Managers work face to face with their injured workers and medical providers to facilitate; though advocacy, progressive medical treatment, and timely ... are driven to deliver great work. + Apply your medical /clinical or rehabilitation knowledge and experience to assist in...the next round, a recruiter will be in touch. \# nurse #fieldcasemanager Sedgwick is an Equal Opportunity Employer and… more
- HCA Healthcare (Atlantis, FL)
- …and retirement of our colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no cost or for a low ... as well as free telemedicine services and free AirMed medical transportation. + Additional options for dental and vision...and patient safety program on a day-to-day basis and claims management program and risk management education for the… more
- Public Consulting Group (Tallahassee, FL)
- …and on a team. + Proven working experience in case management, including as a nurse , medical , mental health care manager or a related job + Excellent knowledge ... Third Party Administrator Services + Enhance Health and Public Safety Services + Claims Processing Services and Solutions + Consulting and Advisory Services + Cost… more
- Cleveland Clinic (Stuart, FL)
- …Clinic Core Values and behavioral standards. Coordinates with nursing, care management, medical staff, and others as appropriate to ensure compliance with all ... improvement. + Applies management processes for disclosure of unanticipated outcomes and medical errors. + Frequently presents risk and safety data and efficiently… more
- CVS Health (Tallahassee, FL)
- …members who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current case management and eligibility status. ... 30-day hospital readmissions. **Required Qualifications** - Active and unrestricted Licensed Practical Nurse (LPN) in state of residence - Must possess compact LPN… more
- Elevance Health (FL)
- …make an impact:** + Managing incoming calls or incoming post services claims work. + Determines contract and benefit eligibility; provides authorization for ... and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification and data entry of referral requests… more