- St. George Tanaq Corporation (Tallahassee, FL)
- …Requirements **Required Experience and Skills** + One (1) year of Medicare appeals, medical review , clinical, healthcare regulatory interpretation/application, ... Dispute Resolution Reviewer I Fully Remote*GA Job Type Full-time Description...university in healthcare or related discipline Additional experience in Medicare appeals, medical review , clinical, or other… more
- AdventHealth (Altamonte Springs, FL)
- …collaboration with physicians, nursing and HIM coders, the Second Level Reviewer I strategically facilitates and obtains appropriate and quality physician ... complexity of care of the patient. The Second Level Reviewer I educates members of the patient care team...(ROM), and quality. . Completes accurate and timely record review to ensure the integrity of documentation compliance. .… more
- St. George Tanaq Corporation (Tallahassee, FL)
- …Experience and Skills** + Must have 2-3 years of medical dispute resolution or Medicare appeals, medical review , clinical, or related experience in a healthcare ... Dispute Resolution Reviewer III Fully Remote*GA Job Type Full-time Description...and impartial and supports the determination made, and documents review + Makes sound, independent decisions based on medical… more
- Centers Plan for Healthy Living (Margate, FL)
- …for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works within a multidisciplinary team to help identify and manage ... their home to improve their quality of life. Utilization Management Clinical Reviewer will assess and process all authorization requests to determine medical… more
- Humana (Palm Bay, FL)
- …caring community and help us put health first** Are you passionate about the Medicare population, looking for an opportunity to work in sales, and wanting the ... through service, organizations, activities and volunteerism + Experience selling Medicare products + Bilingual with the ability to speak,...and therefore subject to driver license validation and MVR review . + Any Humana associate who speaks with a… more
- Elevance Health (Tampa, FL)
- …for Medicare fee for service and assisting nurses as needed with review of claims. Works with other Medicare Administrative Contractor (MAC) Medical ... **Medical Director- Medicare Fee for Service** Location: This role enables...collaborative policies. May participate in MAC policy workgroups to review coverage criteria for existing services or new services… more
- Humana (Tallahassee, FL)
- …group practice management + Utilization management experience in a medical management review organization, such as Medicare Advantage and managed Medicaid + ... other sources of expertise. The Behavioral Health Medical Directors will learn Medicare , Medicare Advantage and Medicaid requirements, and will understand how… more
- Humana (Tallahassee, FL)
- …and Managed Medicaid. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or ... teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements and will understand how to… more
- Prime Therapeutics (Tallahassee, FL)
- …our passion and drives every decision we make. **Job Posting Title** Mgr Medicare Part D Pharmacy Programs - Remote, Pennsylvania **Job Description** Manages the ... coordination of benefits in the pharmacy program with Medicare Part D plans. Provides the technical and leadership...$74,000.00 - $118,000.00 based on experience and skills. To review our Benefits, Incentives and Additional Compensation, visit our… more
- Molina Healthcare (Jacksonville, FL)
- …Summary** Responsible for leading, organizing and directing the activities of the Medicare Contracted Provider Post-Pay Claim Appeals and Disputes in accordance with ... the standards and requirements established by the Centers for Medicare and Medicaid. **Knowledge/Skills/Abilities** * Leads, organizes, and directs the activities of… more