- Actalent (Sunrise, FL)
- …management + InterQual + Milliman Commercial Guidelines + Medicaid + Medical management + Medicare + Managed care + Patient care + Medical record + Case management + ... Concurrent review + Discharge planning + Medical + Acute care Additional Skills & Qualifications + Current unrestricted Florida RN or LPN License. + Minimum of one year of utilization review experience. + Minimum of one year of experience in discharge planning… more
- Centene Corporation (Tallahassee, FL)
- …of pharmacy experience required, preferably in a managed care environment. + Medicare and/or Medicaid experience preferred. Prior experience using analysis tools or ... systems (ex: web based, custom, proprietary, etc.). Experience in the implementation of quality process improvement efforts. Experience documenting requirements, creating training materials and working directly with end users. **License/Certificate:** Florida… more
- CenterWell (Tallahassee, FL)
- …+ Previous experience with pharmacy benefits management + Previous Commercial, Medicare and/or Medicaid experience + Previous clinical experience in managed care ... **Additional Information** + This is a remote position however all candidates must reside in Ohio, Florida, Texas or Arizona + Clinical/PMP Department hours are Monday-Friday 8am-8pm EST - Permanent schedule will consist of 2 closing shifts (11:30am-8pm EST)… more
- Humana (Miramar, FL)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. ... **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic… more
- CVS Health (Tallahassee, FL)
- …of 3 years managing/leading a team. + Experience working in Medicare , Medicaid, or Commercial Health Insurance. **Preferred Qualifications** + Experience working ... in credentialing operations. + Strong written and verbal communication. **Education** + Bachelor's degree preferred or a combination of professional work experience and education. **Pay Range** The typical pay range for this role is: $67,900.00 - $199,144.00… more
- Aveanna Healthcare (Palm Bay, FL)
- …nursing experience + Basic understanding of OASIS As an employer accepting Medicare and Medicaid funds, employees must comply with all health-related requirements in ... all relevant jurisdictions, including required vaccinations and testing, subject to exemptions for medical or religious reasons as appropriate. Notice for Job Applicants Residing in California (https://www.aveanna.com/CaliforniaPrivacyNotices.html) Apply more
- BayCare Health System (Largo, FL)
- …paperwork issues. + One UR will be responsible for a minimum of 100 Medicare Admissions per month. **Position details:** + **Location:** Hybrid - Largo, FL + ... **Status:** PRN, As Needed + **Schedule:** Monday - Friday 8:00 AM - 5:00 PM + **Weekend requirement:** Occasional + **On Call:** No **Certifications and Licensures:** + Required RN License - Florida + Preferred Case Management Certification **Education:** +… more
- CVS Health (Tallahassee, FL)
- …engaging on multiple platforms - Demonstrated understanding of insurance, Medicaid, Medicare billing requirements - Evidence of strong crisis intervention skills - ... Previous experience in a mental health clinic or hospital setting **Education** - Completed Master's degree program from an accredited College or University. - **Multistate License Required.** Licensed Clinical Social Worker (LCSW), Licensed (Clinical)… more
- American Express (Sunrise, FL)
- …company guidelines and service level agreements. + Responsible for timely and accurate Medicare and other State or Federal claims data reporting and validation. + ... Maintain results at meets or above across multiple KPIs + Manage additional administrative duties for the insurance and benefits claims teams such as control reports, correspondence review and distribution, etc. **This position is based in Phoenix, AZ and the… more
- Aveanna Healthcare (Miami, FL)
- …* Bilingual (English and Spanish) * Valid CPR As an employer accepting Medicare and Medicaid funds, employees must comply with all health-related requirements in all ... relevant jurisdictions, including required vaccinations and testing, subject to exemptions for medical or religious reasons as appropriate. Notice for Job Applicants Residing in California (https://www.aveanna.com/CaliforniaPrivacyNotices.html) Apply more