- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- … medical necessity for the requested level of care/patient status to the Medical Director . + Proactively identifies and resolves delays and obstacles for safe ... of resources, avoidable days/denials. Works in collaboration with Appeals Management/ Medical Director in the appeals process. +...accurately and in a timely manner. + Adheres to Medicare and Medicaid regulatory guidelines as it pertains to… more
- CenterWell (Callahan, FL)
- … medical expertise with the care team through daily huddles. . Helps Regional Medical Director (RMD) and Center Administrator (CA) in setting a tone of ... medicine, continuity of care, health maintenance, and disease prevention. Keeps a medical history and medical records. Refers the patient to specialists… more
- CenterWell (The Villages, FL)
- …audits/billing are completed timely and in compliance with Medicare regulations. + Coordinates communication between team members/attending physicians/caregivers ... of care and outcome planning. + Works in conjunction with the Branch Director and Company Finance Department to establish location's revenue and budget goals. +… more
- AdventHealth (Altamonte Springs, FL)
- …under the general supervision of the Care Managment Supervisor or Manager or Director of Nursing and is responsible for patient evaluations of post-hospital needs; ... Care coordination, discharge planning, transitions of care planning and understanding of medical necessity are core competencies of this role. The RN Care Manager… more
- Aveanna Healthcare (Sarasota, FL)
- …the client's physician, therapists or other care givers. + Provide input to the Medicare Director regarding the need for formulation or modification of agency ... on clinical diagnosis, client and physician input that includes medical and social interventions and measurable goals or outcomes....work experience + Valid CPR As an employer accepting Medicare and Medicaid funds, employees must comply with all… more
- HCA Healthcare (Fort Pierce, 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 ... health coverage as well as free telemedicine services and free AirMed medical transportation. + Additional options for dental and vision benefits, life 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 ... health coverage as well as free telemedicine services and free AirMed medical transportation. + Additional options for dental and vision benefits, life and… more
- Aveanna Healthcare (Fort Myers, FL)
- …and plan of care under the direction and supervision of the Director of Clinical Services/Clinical Field Staff Supervisor. Psychiatric mental health registered ... care through physician orders, client input, and nursing assessment to include medical interventions and measurable goals and outcomes. + Educate clients and their… more
- Cardinal Health (Tallahassee, FL)
- …and proactively provides guidance and trainings on policies. Reporting to the Director , Ethics & Compliance, this position supervises and manages audits to determine ... detection and correction of documentation, coding, and billing errors and/or medical necessity of services billed. Particular areas of focus include: evaluation… more
- Actalent (Sunrise, FL)
- …and appropriateness using standardized Review Criteria. + Coordinate with the Medical Director /Physicians for requests outside standard Review Criteria. + ... assigned caseload. + Serve as a liaison between the Medical Director , physicians, and office staff to...+ InterQual + Milliman Commercial Guidelines + Medicaid + Medical management + Medicare + Managed care… more