Medicaid Clinical Review jobs in Palm Harbor, FL

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Expedited Claims Appeals Representative
Review, research and understand how an authorization submitted by consumers and physicians/providers was processed and determine why it was denied....
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Manager Clinical Quality - Tampa, FL - #121232
The Manager Clinical Quality will be responsible for managing the day-to-day activities of one or more clinical quality program components of the Florida...
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State Pharmacy - Director
WellCare - 542 reviews - Tampa, FL
Provides clinical reviews of DER request as time permits. Provides drug utilization review. Assists in educating clinical pharmacist managers for the region...
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Expedited Claims Appeals Representative - Oldsmar, FL

UnitedHealth Group - 4,043 reviews - Oldsmar, FL 34677
Review, research and understand how an authorization submitted by consumers and physicians/providers was processed and determine why it was deniedIdentify and...

Supervisor, Non-Clinical, Case and Disease Management

Freedom Health - 28 reviews - Tampa, FL 33614
Supervises the daily process through department staff including review and analysis of daily reports and productivity as well as timeliness against established...

Manager Clinical Quality

Anthem, Inc. - 1,664 reviews - Tampa, FL
The Manager Clinical Quality will be responsible for managing the day-to-day activities of one or more clinical quality program components of the Florida...

Registered Nurse (RN) - Clinical Documentation Specialist- F...

FH North Pinellas - Adventist Health System - Tarpon Springs, FL 34689
Performs admission reviews for a specific patient population using clinical documentation guidelines. Assists with preparation and presentation of clinical...

Medical Office Manager - Palm Harbor

In Health MD Alliance - Palm Harbor, FL  +1 location
Reviews all monthly HEDIS and MRA Reports. Address employee’s issues in a timely fashion and perform Employee Performance reviews....
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Clinical Services Specialist

WellCare - 542 reviews - Tampa, FL 33634
Reviews all programs assigned and continuously ensure they meet the rigorous standards that are set forth by WellCare's clinical services department....

Clinical Assessor

Sequel Youth and Family Services - New Port Richey, FL
Attend clinical supervision as required by the Clinical Director. And treatment plan reviews. Complete all required clinical documentation within one week of...

Claims Coding Specialist

WellCare - 542 reviews - Tampa, FL 33634
Review medical records to ensure coding is consistent with the services billed and compares against the clinical coding guidelines in order to decide if a claim...

Clinical Quality Specialist

WellCare - 542 reviews - Tampa, FL 33634
Participates in the development and ongoing review of audit tool clinical elements that accurately capture adherence with required standards....

Mgr I or II HCMS (Inpatient UM)

Anthem, Inc. - 1,664 reviews - Tampa, FL
Certified Utilization Review Certification preferred. Reviews benefit systems and cost benefit analysis....
Value-Based Revenue Auditor/Coder II
Review upcoming appointment spreadsheet to determine if coding review is needed based on preset criteria. Demonstrated medical and clinical knowledge....
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