- Centene Corporation (Tallahassee, FL)
- …risk management and sentinel events related to quality of care issues. + Audit medical records, review administrative claims and analyze data and ... Cause Analysis experience preferred** **Florida Medicaid** **Position Purpose:** Conduct review of delegated entities for compliance with quality, service… more
- Zelis (FL)
- …Guidelines, AHA Coding Clinic and client specific coverage policies. Conduct prompt claim review to support internal inventory management to achieve greatest ... plan, and policy exclusions. Conduct reviews on inpatient DRG claims as they compare with medical records...standards regarding privacy What you'll bring to Zelis: + Registered Nurse licensure preferred + Inpatient Coding… more
- Sedgwick (Tallahassee, FL)
- …the ADA process for claimants requesting accommodations under the ADAAA; to review complex medical information for temporary and permanent accommodation ... and/or client requirements. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Reviews medical information for ADAAA temporary and permanent accommodation requests. +… more
- CVS Health (Tallahassee, FL)
- …+ 3+ years of clinical experience in a healthcare setting. + 2+ years as a Registered Nurse ( RN ) or License Practical Nurse / License Vocational ... Nurse . + Active, current, and unrestricted RN /LVP/LPN license in the state of residence. + Proficiency in Microsoft Office Suite (Outlook, Excel) and ability to… more
- Humana (Tallahassee, FL)
- …timeframe **Use your skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) Compact license, with no disciplinary action ... us put health first** The Utilization Management Behavioral Health Nurse 2 utilizes clinical nursing skills to support the...Health Provider Disputes based on the business need + Review and extract information from claims +… more
- AdventHealth (Ormond Beach, FL)
- …in Patient Safety (CBPPS) + Certified Professional in Healthcare Risk Management (CPHRM) + Registered Nurse ( RN ) + Six Sigma (SS) This facility is ... we are even better. **Schedule:** Full-Time **Shift:** Days **Location:** AdventHealth Medical Group East FL **The community you'll be caring for** **:**… more
- Veterans Affairs, Veterans Health Administration (West Palm Beach, FL)
- …also serve as a role model for peers, Advanced Registered Nurse Practitioners, Physician Assistants, Residents and Medical Students. Physicians in Geriatrics ... For more information, refer to Required Documents below. West Palm Beach VA Medical Center is recruiting for a Physician (Geriatrics). The Geriatrics & Extended Care… more
- HCA Healthcare (Atlantis, FL)
- …patient safety and promoting quality care. **What qualifications you will need:** + Registered Nurse or other allied health professional + Bachelors Degree in ... colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no...and patient safety program on a day-to-day basis and claims management program and risk management education for the… more
- MyFlorida (Miami, FL)
- …examination by a licensed physician, physician assistant, or licensed advanced practice registered nurse , based on specifications established by the commission. ... but are not limited to fraud against the Medicaid Program, false claims against the Medicaid program, investigating possible criminal violations of any applicable… more
- HCA Healthcare (Trinity, FL)
- …related field required; Master's Degree preferred .Current Florida licensure as a Registered Nurse preferred _**If serving as facility's primary Risk Manager, ... and retirement of our colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no cost or for a low… more