- 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)
- …is a key member of the Medical leadership team, providing timely medical review of service requests. Oversees the Surgery Field Medical Directors and interacts with ... Manager. + Provides medical direction to the support services review process. Responsible for the quality of utilization ...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… 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
- 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
- Molina Healthcare (FL)
- …administration of contracts with State and/or Federal governments for Medicaid, Medicare , Marketplace, and other government-sponsored programs to provide health care ... of deliverables/submission between staff and governmental agencies and contract review . * Maintains calendar and databases documenting regulatory filings, approvals… more
- Prime Therapeutics (Tallahassee, FL)
- …help ensure efficient and effective solutions are implemented + Perform and review detail plans to address complex compliance issues by identifying goals, ... Management organization, or within a highly regulated industry, including experience with Medicare , Medicaid, and the Affordable Care Act (ACA) + Must be eligible… more
- CenterWell (Jacksonville, FL)
- …quality of care, clinical outcomes, and avoidable utilization + Periodically review clinician charts to identify opportunities in care, ensuring clinical assessments ... indicators (KPIs), such patient experience via Net Promoter Score (NPS) and Medicare clinical quality via HEDIS, meeting local and organizational goals + Personally… more
- Datavant (Tallahassee, FL)
- …work environment. + Keep up to date with current coding policies for ICD-10, Medicare Advantage, HHS (ACA), and other markets. + Provide guidance and make strategic ... or inpatient setting. + Current CCS, CRC, or CPC required. + Previous Medicare Advantage Risk Adjustment, CDI, Medicaid, Commercial RA, and HEDIS experience. +… more