- Actalent (Orlando, FL)
- …Technician to join our team. In this role, you will primarily support Medicare and Medicaid patients by managing the intake and processing of prior authorizations. ... entering prior authorization requests into our system and coordinating with review technicians. Training opportunities are available for those interested in… more
- Walgreens (St. Petersburg, FL)
- …are correctly authorized and required documentation is on file. + Ensure all Medicare documentation is received from the medical provider and submitted to Danville. ... + Review reports to maximize generic substitution opportunities. + Manage...to submitting medical claims, including but not limited to Medicare submission, knowledgeable in EOB (explanation of benefits), remittance… 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) . APP, ... not limited to , onboarding and mentorship of new staff , development, review , and implementation of unit specific competencies, and annual evaluations. This role… more
- Evolent (Tallahassee, FL)
- …available, within the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance… more
- Insight Global (Tampa, FL)
- …Adjustment Medical coders to support a backlog for inpatient and outpatient Medicare advantage projects . Must obtain an active Coding certification (CPC) through ... and non-HCC codes. These markets are still only reviewing Medicare Advantage members. I would say 20-30% of our...I would say 20-30% of our work require CPT review . Also, most of the projects are concurrent coding.… more
- Evolent (Tallahassee, FL)
- …provides clinical rationale for standard and expedited appeals. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD ... review process to reflect appropriate utilization and compliance with...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Evolent (Tallahassee, FL)
- …available, within the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance… more
- Actalent (Sunrise, FL)
- …in complex cases, develops internal processes, and educates physicians on utilization review issues. The role involves managing continuity of care, ensuring smooth ... patient satisfaction, safety, and appropriate length of stay. Responsibilities + Review prior authorization requests for medical necessity and appropriateness using… more
- Actalent (Orlando, FL)
- …information when needed, and forwarding cases to pharmacists for final review and determination. Responsibilities + Process and manage denied prior authorization ... requests for Medicare and Medicaid patients. + Make 30-60 outbound calls...members, primarily elderly individuals, regarding denied medication requests. + Review submitted documentation and gather additional information to support… more
- AdventHealth (Orlando, FL)
- …patient and involved care givers (as permitted by the patient) as well as a review of the current and past inpatient and outpatient medical record in the Initial ... and updates, as needed. Actively participates in daily Multidisciplinary Rounds to review progression of care and discharge plan for all assigned patients.… more