- Molina Healthcare (Miami, FL)
- JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary ... 2 years experience, including experience in hospital acute care, inpatient review , prior authorization, managed care, or equivalent combination of relevant education… more
- CVS Health (Tallahassee, FL)
- …research, analyze and document analytic leads or referrals to send for investigative review . + Review company clinical and payment policies to determine the ... impact of the scheme on Aetna business. + Keep current with new and emerging fraud, waste, and abuse schemes and trends through training sessions and industry resources. + Communicate with colleagues, verbally and in writing, findings related to data analysis… more
- BayCare Health System (St. Petersburg, FL)
- …respect, responsibility and clinical excellence. **The Team Lead Utilization Review responsibilities include:** + Directing and coordinating the daily operations ... discounts and more Equal Opportunity Employer Veterans/Disabled **Position** Utilization Review Team Lead **Location** St Petersburg:St Anthonys | Clinical |… more
- Caring Transitions (Lutz, FL)
- …you. Position Summary: We're looking for a detail-oriented and self-motivated Online Auction Review Specialist to help ensure the quality and accuracy of our online ... mission, we would love to have you on our team! Key Responsibilities + Review auction lots and provide feedback on missing details (eg, dimensions, model numbers,… more
- Molina Healthcare (Jacksonville, FL)
- …experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines. **Preferred ... License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). **MULTI STATE / COMPACT LICENSURE** **Individual state licensures which are not part of the compact states are required for: CA, NV, IL, and MI** **WORK… more
- MUFG (Tampa, FL)
- …portfolios to identify deterioration or negative management control trends and review compliance with policies, guidelines, and regulations. + Prepare periodic Risk ... Profile & Monitoring Plans to outline key risk factors and allocate appropriate resources. + Analyze individual credits and/or credit relationships for quality, adherence to approval conditions, the accuracy of risk grading, and adequacy and accuracy of… more
- Intermountain Health (Tallahassee, FL)
- …Provides extraordinary care to our customers through friendly, courteous, and professional service through a broad understanding of account handling processes, ... extraordinary interpersonal skills, and the ability to resolve complex issues in a timely and accurate manner. " **Please note that a video interview through Microsoft Teams will be required as well as potential onsite interviews and meetings."** **The… more
- Santander US (Miami, FL)
- …Contact clients with account information and receiving instructions. * Review and properly complete all documentation regarding Alternative Investments subscriptions ... to secure inbox, verify clients E-banking status and information, download reports to review missing documentation, and other. New Accounts & Updates * Verify that… more
- Florida Atlantic University (Boca Raton, FL)
- …specifications. + Conduct design meetings, manage project budgets and schedules, review and negotiate guaranteed maximum prices, coordinate bidding and subcontractor ... awards; review and approve invoices and contractor pay applications. + Review and coordinate the project schedule to include the construction phase, ensuring… more
- MyFlorida (Tallahassee, FL)
- …findings and prepares recommendations to management for closure or further review of CCC incidents; submits resolution recommendations for management to the ... (IA) forms, including recommendations to management for closure or further review ; submits documented findings and recommendations to the CCC Coordinator Supervisor.… more