- AdventHealth (Altamonte Springs, FL)
- …we are even better. **Shift** : Full-time; Monday-Friday **Job Location** : Remote **The role you will contribute:** Under general supervision of the Director ... in the management of resources entrusted to them. . Reviews concurrent medical record for documentation compliance including completeness and accuracy for severity… more
- CenterWell (Tallahassee, FL)
- …will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review ... Bilingual We offer tangible and intangible benefits such as medical , dental and vision benefits, 401k with company matching,...culture and much more. Travel: While this is a remote position, occasional travel to Humana's offices for training… more
- CVS Health (Tallahassee, FL)
- …the state of Florida and hold a compact license. This is a fully remote role. Standard business hours Monday-Friday with late shift rotation to 8pm EST approximately ... all case management activities with members to evaluate the medical needs of the member to facilitate the member's...a member's overall wellness. -Uses clinical tools and information/data review to conduct an evaluation of member's needs and… more
- CenterWell (Tallahassee, FL)
- …are excited to offer the role of Virtual Physician Collaborator for CenterWell Medical Group, a new virtual care delivery group within CenterWell Senior Primary ... are excited to offer the role of **Virtual Physician Collaborator for CenterWell Medical Group** , a new virtual care delivery group within CenterWell Senior Primary… more
- Centene Corporation (Tallahassee, FL)
- …for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering ... a fresh perspective on workplace flexibility. **Position Purpose:** Performs a clinical review and assesses care related to mental health and substance abuse.… more
- Centene Corporation (Tallahassee, FL)
- …for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering ... benefits including a fresh perspective on workplace flexibility. NOTE: This is a fully remote role. Preference will be given to applicants who reside in Florida, who… more
- Centene Corporation (Spring Hill, FL)
- …equivalent work experience within a managed care environment related to HEDIS record review , quality improvement, medical coding or transferable skill sets that ... related field. **Candidate Experience:** Required: 1+ year of experience in related HEDIS medical record review or quality improvement with experience in data… more
- Monte Nido (Miami, FL)
- …Improvement & Compliance** + Engage in quality improvement initiatives and regularly review psychiatric and medical policies in collaboration with Compliance, ... to realize their healthy selves. **Vice President of Psychiatry** **Monte Nido** **Full-Time/ Remote ** Monte Nido (MNA) is a national leader in eating disorder… more
- Zelis (St. Petersburg, FL)
- …inquiries related to provider disputes. + Utilize the most up-to-date approved Zelis medical coding sources for bill review maintenance. + Communicate and ... disputes as they relate to DRG validation, itemized bill review , and/or clinical claim review Expert Claim...coding guidelines, and supporting the Office of the Chief Medical Officer in managing disputes related to clinical claim… more
- Humana (Hallandale Beach, FL)
- …and requirements to achieve and/or maintain optimal wellness state in a remote telephonic environment. The Behavioral Health Care Manager guides members and/or ... employers offering a variety of professional onsite, field, or remote based opportunities for a period up to 11...utilization and conducts outreach based on acuity to assess medical /social/BH needs and addresses gaps in care. + Participate… more