- Humana (Miramar, FL)
- …Screen physician's orders and documentation to identify that all qualifying medical documentation and required information is included. When necessary, request ... per Health Plan contract. Review referral data matching it against specified medical terms and diagnoses or procedure codes and follow established procedures for… more
- CenterWell (Crestview, FL)
- …a part of our caring community and help us put health first** The Medical Social Worker participates in the interdisciplinary care provided to home health patients. ... The Medical Social Worker functions to evaluate and develop a...gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and… more
- Humana (Fort Lauderdale, FL)
- …for clinical effectiveness within the Medicaid segment. This function integrates Medical Economics, Clinical Insights, and Quality to deliver improved health ... advanced analytical, data science, and leadership capabilities to optimize medical cost management, drive program performance, and support compliant operations.… more
- CenterWell (Tallahassee, FL)
- …expert on payer authorization rules, revalidation requirements, and medical necessity workflows. * Lead large-scale transformation initiatives including ... therapy leadership, and clinical staff to ensure clinical documentation supports medical necessity. * Support resolution of clinical questions related to… more
- CenterWell (Pinellas Park, FL)
- …treats center patients in accordance with standards of care. + Follows level of medical care and quality for patients and monitors care using available data and ... including but not limited to specialty referrals, hospital and SNF coordination, durable medical equipment and home health care. + Acts as an active participant and… more
- CenterWell (Coral Springs, FL)
- …and treats center patients in accordance with standards of care. Follows level of medical care and quality for patients and monitors care using available data and ... including but not limited to specialty referrals, hospital and SNF coordination, durable medical equipment and home health care. Acts as an active participant and… more
- Humana (Tallahassee, FL)
- …skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management ... direction and receives guidance where needed. Follows established guidelines/procedures. + Medical necessity reviews for Medicaid claims and Provider disputes. +… more
- Humana (Tallahassee, FL)
- …communication and available resources to promote quality, cost-effective outcomes. Coordinate medical , behavioral and other services for beneficiaries with a primary ... communication and available resources to promote quality, cost-effective outcomes. Coordinate medical , behavioral and other services for beneficiaries with a primary… more
- CenterWell (Delray Beach, FL)
- …outpatient care to adult and senior patients. + Maintain accurate and timely medical records and documentation. + Diagnose and manage moderately to complex ... medical conditions. + Coordinate referrals and collaborate with specialists...gender identity or religion. We also provide free language interpreter services. See our full accessibility rights information and… more
- Humana (Miramar, FL)
- …of 3 years' experience in the healthcare industry, with a strong understanding of medical terminology. + Proven background in medical billing, specifically as an ... knowledge of accounting principles and practices. + Hands-on experience with medical coding, including proficiency in ICD-10. + Billing and coding certification… more