Medicaid Clinical Review jobs in Palm Harbor, FL

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Compliance Director
Operation PAR, Inc. - 5 reviews - Pinellas Park, FL 33781
Ability to understand clinical systems. Ability to train employees on clinical documentation. Requires five (5) years of experience in clinical documentation....
Easily apply
Quality Improvement Project Manager - Senior
Wellcare - 764 reviews - Tampa, FL 33634
Required Other Knowledge of Medicaid and/or Medicare programs Candidate Skills:. Performs various quality department functions and processes, such as quality of...
Psychiatric APRN (NP or CNS) - Remote Telepsychiatry
FasPsych, LLC - United States
Medicare, Medicaid, SCHIP); Adult Psychiatric-Mental Health Clinical Nurse Specialist. Clinical issues should be brought to the attention of the placement...
Easily apply

Clinical Performance Monitoring Specialist

WellCare - 764 reviews - Tampa, FL 33634
Participates in the development and ongoing review of clinical review tool to ensure that clinical elements accurately capture adherence with required...

Prior Auth, RN Reviewer

UnitedHealth Group - 9,475 reviews - Tampa, FL 33646 (Downtown area)
5+ years’ experience in clinical nursing hands-on Prior Authorization review. Perform / support clinical appeals (e.g., notes, previous reviews, obtain...

Clinical Care Coordinator - RN, LPN, SW

Keystone Peer Review - Tampa, FL
Clinical Care Coordinator. Four years progressively responsible experience in case management, communications, and/or advocacy Experience with project...

UM Nurse

Alignment Healthcare - 17 reviews - Tampa, FL
RN preferred, LVN required with clinical experience. Review referral denials for appropriate guidelines and language....
Easily apply

Program Director

Gulf Coast Jewish Family & Community Services - 25 reviews - Holiday, FL
Ensure clinical documentation within program meets both CARF and Medicaid standards. Perform chart reviews as necessary....
Easily apply

Quality Improvement Manager

WellCare - 764 reviews - Tampa, FL 33634
Participates in the development, review and updating of policies and procedures. Prepares, compiles, reviews and submits monthly and quarterly reports for...

Consultant Physician Reviewer: Radiologist or Pyschiatrist

eQHealth Solutions - 20 reviews - Tampa, FL
Maintain professional behavior in dealing with colleagues and clinical review staff. Apply sound medical judgment and clinical experience during the service...

PATIENT NAVIGATOR

Tampa Family Health Centers - 26 reviews - Tampa, FL 33602 (Downtown area)
HEDIS Medicaid and Medicare Measures. Reviews clinical record to determine specific quality measures each patient needs for their overall healthcare outcomes,...

Surgery Scheduler

Tampa Eye Surgery Center - 154 reviews - Tampa, FL
Commercial, Medicare, Medicaid, HMO/PPO, Tricare insurance operation procedures; Obtains CPT and ICD-9 diagnosis codes and other clinical information as...

Medical Administration Specialist

Taino Consulting Group - Tampa, FL
Reviews health care delivery plans; Must have working knowledge of Department of Defense (DoD), Federal, State, non-profit healthcare systems and organizations,...
Manager, Utilization Management (RDH)
The license has a scope of practice that is relevant to the clinical area(s) addressed in the initial clinical review....
Clinical Performance Monitoring Specialist
WellCare - 764 reviews - Tampa, FL 33634
Participates in the development and ongoing review of clinical review tool to ensure that clinical elements accurately capture adherence with required...