- CenterWell (Fort Lauderdale, FL)
- …defined by Clinical Leadership. . Meets with RMD about quality of care, review of outcome data, policy, procedure and records issues. . Participates in potential ... Medicine or Geriatric Medicine preferred . Active and unrestricted DEA license . Medicare Provider Number . Medicaid Provider Number . Minimum of two to five… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …assist in the development, administration and management of the Health Plan's Medicare Prescription Drug Program, including compliance and oversight of Medicare ... evaluation. The Clinical Pharmacist is the lead for the review and presentation of New Drug Entities, New Generics,...for formulary exceptions and prior authorizations according to the Medicare Part D defined guidelines + Work with the… more
- Humana (Miramar, FL)
- …in the Health Plan contractual agreements. The Pre-Service Coordinator will review inbound referrals and correspondence for processing, fulfilment or resolution ... of benefits coverage and eligibility for services per Health Plan contract. Review referral data matching it against specified medical terms and diagnoses or… more
- Prime Therapeutics (Tallahassee, FL)
- …is responsible for receiving inbound and making outbound calls to qualified members to review the benefits of the MTM programs in addition to assisting the leaders ... in a manner that meets the specialized needs of the targeted population; for Medicare , is Centers for Medicare & Medicaid Services (CMS) compliant + Act… more
- University of Miami (Coral Gables, FL)
- …2 ( Medicare Billing Coding & Financial) works independently to review financial provisions of sponsored clinical research agreements and proposals and negotiate ... faculty or staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The Office of… more
- Prime Therapeutics (Tallahassee, FL)
- …strategy. This role provides leadership and subject matter expertise on Medicare Stars, Medicaid quality and the Commercial/Health Insurance Marketplace Quality ... goals + Drive the client quality strategy for all lines of business ( Medicare , Medicaid, Commercial/HIM); serve as primary point of contact and subject matter expert… more
- Prime Therapeutics (Tallahassee, FL)
- …lines of business (Employer Markets, Health Insurance Marketplace (HIM), Commercial, Medicare , and Medicaid). This individual is the primary relationship and ... Lead retention efforts for Employer Markets, Health Insurance Marketplace, Commercial, Medicare , and Medicaid health plan clients; drive the adoption and consistent… more
- Molina Healthcare (Miami, FL)
- …medical director, and quality improvement staff. + Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews quality referred ... requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial process. + Monitors appropriate care and services… more
- CenterWell (Orlando, FL)
- …defined by clinical leadership. . Meets with RMD about quality of care, review of outcome data, policy, procedure and records issues. . Participates in potential ... Medicine or Geriatric Medicine preferred . Active and unrestricted DEA license . Medicare Provider Number . Minimum of two to five years directly applicable… more
- ChenMed (Miami Gardens, FL)
- …related to appointment, uploading into organization's medical record system for physician review prior to PCP follow-up appointment. + Ensures any missed external ... understanding of the company's patient population, including the complexities of Medicare programs + Exceptional organizational skills with the ability to… more