- Molina Healthcare (Jacksonville, FL)
- …internal compliance program, including annual, periodic, focal, etc. audits. * Request, review and perform oversight of internal corrective action plans (CAPs) for ... it relates to the finding. * Performs support via review and approval for Corporate Operations policies, procedures, guidelines...years or more + 5 years of experience in Medicare , DSNP and CSNP population, Enrollment, A&G, Claims, Compliance,… more
- CVS Health (Tallahassee, FL)
- …to members and providers. As a Medical Director you will focus primarily on review appeal cases for denied medical services. This includes First Level Appeals / ... Second Level Appeals / Expedited Appeals / Appeal Hearings / Special Projects and Committee participation when needed. The Medical Director will provide clinical, coding, and reimbursement expertise as well as directing case management when necessary. The… more
- BAYADA Home Health Care (Orlando, FL)
- …while using the Medicare PDGM billing model and CMS guidelines. + Review and communicate OASIS edit recommendations to each clinician to promote OASIS accuracy. ... Home Health Care is hiring a full time OASIS Review and Coding Manager. The OASIS and Coding ...review . + Knowledge of OASIS, Home Care and Medicare regulations + Excellent organizational, interpersonal and communication skills… more
- BAYADA Home Health Care (Orlando, FL)
- …while using the Medicare PDGM billing model and CMS guidelines. + Review and communicate OASIS edit recommendations to each clinician to promote OASIS accuracy. ... Utilization Review , Quality Assurance, Remote, Home Health Coding, Coder, Medicare **As an accredited, regulated, certified, and licensed home health care… more
- Evolent (Tallahassee, FL)
- …for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to make a meaningful impact ... reviews for cardiovascular cases, serving as a specialty-matched expert reviewer for invasive/interventional cardiology cases (eg, cardiac catheterizations, coronary… more
- Actalent (Sunrise, FL)
- …staff to direct utilization and capture data effectively. Responsibilities + Review prior authorization requests for medical necessity and appropriateness, utilizing ... standardized Review Criteria. + Coordinate with the Medical Director/Physicians for...Milliman Commercial Guidelines + Medicaid + Medical management + Medicare + Managed care + Patient care + Medical… more
- HCA Healthcare (Gainesville, FL)
- …**Introduction** Do you have the career opportunities as a Revenue Integrity Charge Review Analyst you want with your current employer? We have an exciting ... group of colleagues. Do you want to work as a Revenue Integrity Charge Review Analyst where your passion for creating positive patient interactions is valued? If you… more
- HCA Healthcare (Tampa, FL)
- …to join an organization that invests in you as a Pro Fee Coding Quality Review Educator? At Parallon, you come first. HCA Healthcare has committed up to $300 million ... are looking for a dedicated Pro Fee Coding Quality Review Educator like you to be a part of...of unique coding requirements for major payers such as Medicare , Medicaid, HMO's, PPO's, IPA's, employers, etc. + Demonstrate… more
- Actalent (Miami, FL)
- …setting of care. Essential Skills + Proficiency in utilization management and utilization review + Experience with Interqual and Medicare + Expertise in medical, ... Job Title: Clinical Review Nurse Job Description As a Clinical Review Nurse, you will perform concurrent reviews to assess members' overall health, review … more
- Evolent (Tallahassee, FL)
- …Reviewers. **What You Will Be Doing:** + Serve as the specialty match reviewer in Cardiology cases, that do not initially meet the applicable medical necessity ... the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more