Medicaid Clinical Review jobs in Palm Harbor, FL

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The Specialist will work with clinical staff and revenue cycle departments to proactively develop charge codes for new procedures....
Field RN
Prepares and presents patient’s record to the Clinical Record Review Committee as indicated. Medicare and Medicaid Guidelines:....
Easily apply
RN MDS Coordinator
Auburndale Oaks/ West Jacksonville Health - Florida
Knowledge of Medicaid and Medicare. Provide clinical support and direct to appropriate resource materials. Observe direct nursing care, review documentation and...
Easily apply

Licensed Utilization Review II (Call Center Nurse)- Tampa, F...

Anthem, Inc. - 3,091 reviews - Tampa, FL
Review of claim edits, pre-noted inpatient admissions or, episodic outpatient therapy such as physical therapy that is not associated with a continuum of care,...

Wellness Director

Bloom at St. Petersburg - Saint Petersburg, FL
$23 - $25 an hour
Understands and reviews the community's Healthcare Clinical Policies and Procedures. Reviews resident treatment plans on a routine basis....

Clinical Performance Monitoring Specialist

WellCare - 915 reviews - Tampa, FL 33607 (Carver City area)
Participates in the development and ongoing review of clinical review tool to ensure that clinical elements accurately capture adherence with required...

Targeted Case Manager

Camelot Community Care, Inc. - Clearwater, FL 33760
Responds quickly to Utilization Review issues and confers with the Clinical Director on any issues of over or underutilization of services....
Easily apply

Quality Registered Nurse - Medicaid - Tampa Florida Office

Humana - 4,173 reviews - Tampa, FL
$68,000 - $74,000 a year
At least 1 year of auditing and chart review experience in one or more of the following areas, prior authorization, care management, utilization management,...
Easily apply

Clinical Delegation Oversight Auditor

WellCare - 915 reviews - Tampa, FL 33634
Licensed Clinical Social Worker (LCSW). Experience in State Medicaid or Federal managed care compliance....

Clinical Policy Coding Analyst

WellCare - 915 reviews - Tampa, FL 33634
Directs the initial review of coding in Clinical Coverage Guidelines (CCGs) to support the Medical Management Team by reviewing and updating evidence based...

Clinical Documentation & Coding Specialist

University of South Florida - 463 reviews - Tampa, FL
Experience in a physician practice setting, including associated business practices and clinical operations....

Clinical Counselor

Children's Home Society of Florida - 132 reviews - Lutz, FL
Review and monitor billing for clinical services. Provide clinical and supportive counseling services; Participate in peer review process to oversee that...

Medical Policy Document Coordinator

Avalon Healthcare Solutions - 2 reviews - Tampa, FL
Updating Clinical Advisory Board (CAB) process schedules. Monitor for national coverage determinations (NCD), local coeverage determination (LCD), Medicaid, and...
Specialized Therapeutic Foster Care Therapist
Families First of Florida, LLC - Tampa, FL
Attends regular staff meetings, clinical meetings, and one-on-one session with the Clinical Supervisor in order to process the current status of cases....
Easily apply
Bilingual Office Manager
IMA Medical Group - 31 reviews - Saint Petersburg, FL
Reviews all monthly HEDIS and MRA Reports. Address employee’s issues in a timely fashion and perform Employee Performance reviews....
Easily apply