• Medical Director-Payment Integrity

    Humana (Tallahassee, FL)
    …of decisions to internal associates. The clinical scenarios predominantly arise from inpatient or post-acute care environments. A remote possibility exists of ... level of care, and/or requested site of service should be authorized at the Inpatient level. All work occurs within a context of regulatory compliance, and work is… more
    Humana (09/26/25)
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  • Medical Claim Review Nurse (RN)

    Molina Healthcare (Tampa, FL)
    …Looking for a RN that has a current active unrestricted license This a remote role and can sit anywhere within the United States. Work Schedule Monday to ... for a RN with experience with appeals, claims review, and medical coding . **Job Summary** Utilizing clinical knowledge and experience, responsible for review of… more
    Molina Healthcare (09/06/25)
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  • Medical Director - Southeast Region

    Humana (Tallahassee, FL)
    …participation in care management. The clinical scenarios predominantly arise from inpatient or post-acute care environments. Has discussions with external physicians ... require conflict resolution skills. Some roles include an overview of coding practices and clinical documentation, grievance and appeals processes, and outpatient… more
    Humana (09/10/25)
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  • Medical Director - Claims Management

    Humana (Tallahassee, FL)
    …may require conflict resolution skills. Some roles include an overview of coding practices and clinical documentation, dispute, grievance, and appeals processes, and ... post residency or fellowship, which preferably includes some experience in an inpatient environment and/or related to care of a Medicare type population (disabled… more
    Humana (09/17/25)
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  • Epic Solutions Architect 2 - Central (H)

    University of Miami (Miami, FL)
    …please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . * REMOTE * The University of Miami Health System, ... or a related field. Master's degree is desirable + Coding Certification (eg CPC, CCS, CIC, CMC) from an...+ Knowledge of operational healthcare, hospital and/or ambulatory and inpatient workflows and medical terminology. + Ability to communicate… more
    University of Miami (07/25/25)
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