- University of Miami (Medley, FL)
- … Medicare Severity Diagnostic Related Groups (MS-DRG) assignment. + Review medical record documentation for major complications and comorbidities (MCC), ... faculty or staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The University of… more
- Otsuka America Pharmaceutical Inc. (Tallahassee, FL)
- …territory plans through partnerships with internal and external stakeholders + Review and educate offices on payer policies, including prior authorization ... in rare disease + Strong knowledge of Centers for Medicare & Medicaid Services (CMS) policies and processes, especially... & Medicaid Services (CMS) policies and processes, especially Medicare Part D + Experience in "Buy and Bill"… more
- AdventHealth (Maitland, FL)
- …**The role you'll contribute:** **This position is responsible for physician contract review and interpretation; as well as, the building and maintenance of rates ... necessary research to obtain and maintain non-contracted payer reimbursement including Medicare , Medicaid, Tricare and other gov't payers. * Responsible for ensuring… more
- Cardinal Health (Tallahassee, FL)
- …about long and short-range changes in the reimbursement environment including Medicare , Medicaid, Managed Care, and Commercial medical and pharmacy plans while ... High School diploma or equivalent preferred + Knowledge of Medicare (A, B, C, D), Medicaid & Commercial payers...other status protected by federal, state or local law._ _To read and review this privacy notice click_ here… more
- Cardinal Health (Tallahassee, FL)
- …a call center or customer service environment, preferred + Clear knowledge of Medicare , Medicaid & Commercial payer policies and guidelines for coverage, preferred + ... Knowledge of Diagnostic Medical Expense and Medicare Administrative Contractor practices, preferred + Clear understanding of...other status protected by federal, state or local law._ _To read and review this privacy notice click_ here… more
- CenterWell (Ormond Beach, FL)
- …defined by Clinical Leadership. . Meets with RMD about quality of care, review of outcome data, policy, procedure and records issues. . Participates in potential ... two to five years directly applicable experience preferred . Experience managing Medicare Advantage panel of patients with understanding of Best Practice in… more
- Prime Therapeutics (Tallahassee, FL)
- …all provider and member materials and communications, and product ownership for Medicare and Medicaid formularies + Provide consultation and recommendations to the ... experience + Knowledge of the applicable line of business (eg, Medicare , Medicaid, Exchange, Commercial, Employer Group) Every employee must understand, comply… more
- HCA Healthcare (Coral Springs, FL)
- …public nursing or acute hospital nursing experience + Familiar with Medicare home health regulations, documentation requirements, ICD-10 coding and PPS (Strongly ... quality care during their recovery at home. We are Medicare certified. Our patients are under the supervision of...PRN RN Home Health opening. Our team will promptly review your application. Highly qualified candidates will be contacted… more
- Humana (Tallahassee, FL)
- …residence + Eligibility to participate in federal prescription programs (eg, Medicare /Medicaid) + Self-directed with the ability to work effectively both ... + Experience in managed care pharmacy, particularly in utilization management review **Additional Information:** **Interview Format** : As part of our… more
- Aveanna Healthcare (West Palm Beach, FL)
- …and "Re-evaluations" to transition patients from facilities to home care. + Review physicians' orders and update care plans and documentation as needed. + ... to infants, children, adolescents, and adults. Note: As an employer receiving Medicare and Medicaid funds, Aveanna employees must comply with all health-related… more