- Molina Healthcare (Tampa, FL)
- …Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, or other ... MCG, InterQual or other medically appropriate clinical guidelines, Medicaid, Medicare , CHIP and Marketplace, applicable State regulatory requirements, including the… more
- Centene Corporation (Tallahassee, FL)
- …pharmacy calls regarding the prior authorization and formulary process + Perform review of pharmacy and override process in compliance with pharmaceutical related ... the health plan's pharmacy process + Assist with the pharmacy utilization review and reporting process + Collaborate with Quality Improvement department with various… more
- Centene Corporation (Tallahassee, FL)
- …pharmacy calls regarding the prior authorization and formulary process + Perform review of pharmacy and override process in compliance with pharmaceutical related ... the health plan's pharmacy process + Assist with the pharmacy utilization review and reporting process + Collaborate with Quality Improvement department with various… more
- HCA Healthcare (Atlantis, FL)
- …implement and supervise the activities of the Safety Management Program by: Periodic review and update of all safety management policies and procedures to include, ... management plan, and fire safety and evacuation plan to comply with JCAHO, Medicare , OSHA, and other regulatory agencies; Coordinate and implement fire and emergency… more
- Humana (Tallahassee, FL)
- …security architecture standards, and guiding engineering teams through the Technology Review Board and Architecture Review Board processes and participating ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … 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
- 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
- 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
- Cognizant (Tallahassee, FL)
- …team and collaborate with stakeholders and other teams. **Primary Responsibilities** : + Review claim system data and verify against UB or HCFA paper or EDI ... UB/institutional (CMS-1450) and/or professional (CMS 1500) claims. + Knowledge of Medicare /Medicaid payment and coverage guidelines and regulations. + Must be able… more
- Elevance Health (Tampa, FL)
- …to refer or assign case (utilization management, case management, QI, Med Review ). + Provides information regarding network providers or general program information ... all actions. + Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical information. **Minimum… more