- Molina Healthcare (Miami, FL)
- …care fraud, waste, and abuse. Duties include performing accurate and reliable medical review audits that may also include coding and billing reviews. The SIU ... also entails producing audit reports for internal and external review . The position may also work with other internal...+ Knowledge of Managed Care and the Medicaid and Medicare programs as well as Marketplace. + Understanding of… more
- University of Miami (Miami, FL)
- …staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The ... the Division of Rheumatology. + Draft of original correspondence for Chief Review and signatory (eg letter of recommendations, letters to editors, letters responding… more
- Prime Therapeutics (Tallahassee, FL)
- …signoff of deliverables by all impacted parties + Facilitate solution design review discussions between IT resources and business requestors to resolve questions ... requested software changes, and participate with Quality Assurance and UAT resources to review related test cases and/or scenarios + Serve as subject matter expert… more
- Datavant (Tallahassee, FL)
- …outcomes, measure product impact, and support value-based client delivery across Medicare Advantage, ACA, and Medicaid programs. The ideal candidate combines deep ... protected status. To learn more about our commitment, please review our EEO Commitment Statement here (https://www.datavant.com/eeo-commitment-statement) . Know Your… more
- University of Miami (Miami, FL)
- …staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The ... members, including participating in weekly project team meetings. + Review the status of projects and issues on an...and maintain Clinician's workflow and HEDIS quality measure for Medicare Advantage programs + Build and maintain CMS Quality… more
- HCA Healthcare (Sarasota, FL)
- …the preparation of the annual financial reports including but not limited to: Medicare Cost Report, work paper package and the AHCA prior year report package. ... procedures. + You will assist in the preparation, coordination, review , and compilation of the capital and operating budgets...trend performance. We have been named by Becker's Hospital Review among the top 100 hospitals with great orthopedic… more
- CenterWell (Tallahassee, FL)
- …call related include but are not limited to: + **Pharmacist Care Plan/Treatment Review ** + Review prescriptions for accuracy + Check for drug-drug interactions ... + Previous experience with pharmacy benefits management + Previous Commercial, Medicare and/or Medicaid experience + Previous clinical experience in managed care… more
- CVS Health (Tallahassee, FL)
- …(PQOC) nurse investigator team manager. This position is responsible for the review and evaluation of protected clinical information and documentation. The PQOC team ... Patient Safety Events across all lines of business (Commercial, Medicare , and Medicaid). Independently coordinates the clinical resolution with internal/external… more
- HCA Healthcare (Miami, FL)
- …leadership + Work with team members in billing, revenue integrity and/or the Medicare Service Center to resolve alerts/edits + Assign interim DRGs for in-house ... lead, manager, international log) + Periodically works with manager to review individual work accomplishments, discuss work problems/barriers, discuss progress in… more
- Gentiva (Winter Garden, FL)
- …Group (IDG), as assigned, including presiding over IDG, presentation of patients for review , coordination of minutes, review of patient charts to note and ... practice, including industry standards, regulations, and best practices (ie, Medicare , Medicaid, JCAHO, ACHC), company policies/procedures, and understanding ofterminally… more