- Molina Healthcare (Miami, 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 SCHEDULE: Mon… more
- CVS Health (Tallahassee, FL)
- …providers, claimants, etc. - Researches and prepares cases for clinical and legal review . - Documents all appropriate case activity in case tracking system. - ... Prepares and presents referrals, both internal and external, in the required timeframe. - Facilitates the recovery of company lost as a result of fraud matters. - Assists team in identifying resources and best course of action on investigations. - Cooperates… more
- Molina Healthcare (St. Petersburg, 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
- Molina Healthcare (Jacksonville, FL)
- …+ Provides telephone, clerical, and data entry support for the Care Review team. + Provides computer entries of authorization request/provider inquiries, such as ... eligibility and benefits verification, provider contracting status, diagnosis and treatment requests, coordination of benefits status determination, hospital census information regarding admissions and discharges, and billing codes. + Responds to requests for… more
- Community Health Systems (Naples, FL)
- …improvement programs + Addresses facility and departmental communication through daily review of all correspondence, including incoming email messages. + Performs ... other duties as assigned. + Complies with all policies and standards. **Qualifications** + Associate Degree Graduate from an Accredited School of Nursing, ASN required or + Bachelor's Degree BSN required + 2-4 years clinical practice experience required +… 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. **Essential Functions** + Identifies appropriate payment details and saves back-up as appropriate. + Researches, validates and makes adjustments to… more
- Molina Healthcare (Jacksonville, FL)
- …ARIZONA RESIDENCY REQUIRED** This position will support the Arizona state Plan. We are seeking a candidate with an Arizona RN/and or a compact licensure. The ideal ... candidate will have experience with UM and prior authorization, within both Physical Health and Behavioral Health. Candidates with a Behavioral Health background are highly preferred. Further details to be discussed during our interview process. Remote… more
- Raymond James Financial, Inc. (St. Petersburg, FL)
- …+ Monitors and investigates electronic branch or home office communications through the use of various reports and systems. + Pro-actively monitors and ensures ... discussions pertaining to activities in clients' accounts and activities of financial advisors meet firm requirements and standards. + Communicates findings and manages concerns in a professional manner whether that be written or orally. + Interfaces with… more
- Molina Healthcare (FL)
- …**Job Summary** Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an ... integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and… more