- CVS Health (Tallahassee, FL)
- …case activity in case tracking system. + Prepare written case summaries and make referrals to State and Federal Agencies within the timeframes required by Law. + ... Facilitates the recovery of company and customer money lost as a result of fraud, waste and abuse. + Cooperates with federal, state, and local law enforcement agencies in the investigation and prosecution of healthcare fraud. + Demonstrates high level of… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …social workers, and community resources. + Authorize services and coordinate referrals based on clinical guidelines and insurance coverage. + Provide telephonic ... and/or in-person case management and member education regarding conditions, medications, and treatment options. + Ensure services are cost-effective and meet quality standards, consistent with managed care requirements and clinical best practices. + Maintain… more
- Option Care Health (Tallahassee, FL)
- …equivalent is required. **Basic Qualifications** + Ability to multi-task and support numerous referrals /priorities at one time. + Ability to work in a fast past ... environment. + High degree of self-discipline in maintaining productivity expectations. + Must be detail-oriented and have a high degree of quality focus. **Travel Requirements: (if required)** N/A **Preferred Qualifications & Interests (PQIs)** +… more
- Humana (Miramar, FL)
- …Plan contractual agreements. The Pre-Service Coordinator will review inbound referrals and correspondence for processing, fulfilment or resolution utilizing all ... appropriate software systems and resources. Screen physician's orders and documentation to identify that all qualifying medical documentation and required information is included. When necessary, request additional applicable information from referring entity.… more
- US Tech Solutions (Melbourne, FL)
- …phone, and assists the front office Team Lead with administrative tasks and referrals or prior authorizations from insurance companies. + Dress: Black Polo Shirt and ... Khaki dress pants. **Experience:** + 1 year **Education:** + High school graduate and 1-2 years (Certified Administrative Professional), or two-year associate degree and 1 year of experience in either clerical role or healthcare environment: or high school… more
- Molina Healthcare (Miami, FL)
- …members or providers in consistent and efficient manner. + Makes appropriate referrals to other clinical programs. + Collaborates with multidisciplinary teams to ... promote Molina Care Model + Adheres to UM policies and procedures. + Occasional travel to other Molina offices or hospitals as requested, may be required. This can vary based on the individual State Plan. + Must be able to travel within applicable state or… more
- PruittHealth (Jacksonville, FL)
- …to develop, integrate, and manage the patient care plan of care, making referrals to other disciplines as needed * Demonstrates intermediate knowledge of home care ... and competency in discipline for specific patient care skills, required for the provision of care * Conducts field visits to (1) evaluate & initiate start of care and (2) conduct clinical outcomes monitoring, follow-up and care performance improvement… more
- CVS Health (Coral Gables, FL)
- …ill members/clients across the continuum of care that can include consultant referrals , home care visits, the use of community resources, and alternative levels ... of care. + Interacts with members/clients telephonically and in person. May be required to meet with members/clients in their homes, worksites, acute/post-acute inpatient facilities or physician's office to provide ongoing case management services. + Assesses… more
- University of Miami (Palm Beach, FL)
- …members on additional appointments needed, coordinates test scheduling and referrals . + Answers multiple UHealth Concierge member requests including incoming ... triage calls, responding to patient questions and then documents messages in the appropriate programs such as UCHART/EPIC or Microsoft programs. + Documents all patient interactions in department log to ensure continuity of care. + Reviews Executive Health… more
- Select Medical (Orlando, FL)
- …relationships that help to build business through an increase in referrals and admissions. **Responsibilities** **Position Summary** In this highly visible, ... challenging and rewarding position, you will assume a leadership role, developing and nurturing professional relationships with case managers, physicians and clinicians in acute care hospitals; educating staff, patients and families regarding rehabilitation… more