- Humana (Tallahassee, FL)
- …clinical reference materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage ... Advantage and Managed Medicaid. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid,… more
- Sedgwick (Tallahassee, FL)
- …MAY INCLUDE** + Contacts providers and attorneys to obtain clarification of documentation needed to support the preparation of Medicare Set-Aside allocations. ... Work(R) Fortune Best Workplaces in Financial Services & Insurance Nurse Allocator Medicare **PRIMARY PURPOSE OF THE ROLE:** To perform provider outreach, specialized… more
- AdventHealth (Altamonte Springs, FL)
- …valid clarifications that are easily understood by physicians and other members of the medical team . . Accurately reconciles all cases in CDI Software. . Assists ... of the patient. The CDS educates members of the patient care team regarding documentation guidelines, including physicians, allied health practitioners, nursing,… more
- Medical Mutual of Ohio (Fort Myers, FL)
- …Insurance Portability and Accountability Act (HIPAA) and Protected Health Information (PHI) regulations. Medical Mutual is looking to grow our team ! We truly ... self-funded group coverage, including stop loss, as well as Medicare Advantage, Medicare Supplement, and individual plans....places in and around town, just for being a Medical Mutual team member. + The opportunity… more
- BAYADA Home Health Care (Orlando, FL)
- …and Coding Review Manager provides support to all BAYADA Home Health Care Medicare service offices by monitoring Outcome and Assessment Information Set (OASIS) ... documentation for quality and adherence to policies and procedures. As a member of the Medicare Case Management (MCM) office, individuals in this role are… more
- Humana (Miami, FL)
- …based on business needs and hours could include weekends/holidays. + During the Medicare Annual Election Period, September to December, must be able to work Monday ... member services and a call center environment specifically but not limited to Medicare & Medicaid recipients + Previous experience with electronic case note … more
- CenterWell (Jacksonville, FL)
- …a part of our caring community and help us put health first** The Associate Medical Director (AMD) is an instrumental clinical leader of our primary care team , ... and supervise clinical teams to staff and develop a high-quality clinical team with strong engagement, patient-first culture, and talent retention + Closely engage… more
- Evolent (Tallahassee, FL)
- …(URAC) and National Committee for Quality Assurance (NCQA) guidelines. + Ensures documentation of all communications with medical office staff and/or MD ... culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key member of...will be a key member of the utilization management team . We can offer you a meaningful way to… more
- Evolent (Tallahassee, FL)
- …impact on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director, Cardiovascular Specialist and use your ... (URAC) and National Committee for Quality Assurance (NCQA) guidelines. + Ensures documentation of all communications with medical office staff and/or MD… more
- Evolent (Tallahassee, FL)
- …. Aids and acts as a resource to Initial Clinical Reviewers. . Ensures documentation of all communications with medical office staff and/or MD provider is ... the culture. **What You'll Be Doing:** As a Field Medical Director, Oncology, you will be a key member...will be a key member of the utilization management team . We can offer you a meaningful way to… more