Jobs near Miami: 6,596
RS
Relevance Score ranked on: APPEALS
Manager II Grievance/Appeals (RN)
MIAMI, 11430 NW 20TH ST, STE 300
Maintains and coordinates staff activities to achieve departmental and corporate goals to improve service to customers/providers and assures regulatory compliance. - Analyzes and develops strategies by achieving performance thresholds within budgetary guidelines. - Addresses both internal/external cu...
Search Terms: Manager, Appeals, Administrative, Healthcare, Benefits
84.9
0mi
Updated: September 12
Medical Director-Appeals (Primary Care-IM or FM)
NORTH MIAMI BEACH, 1600 NE MIAMI GARDENS DR.
Appeal Reviews. Supports clinicians to ensure timely and consistent responses to members and providers. Provides guidance for clinical operational aspects of a program. May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss review determ...
Search Terms: Medical Director, Director, Appeals, Medical, Behavioral Health
80.8
12mi
Updated: September 18
LTSS Service Coordinator - Bilingual (English/ Spanish)
Miami
Responsible for performing face to face program assessments (using various tools with pre-defined questions) for identification, applying motivational interviewing techniques for evaluations, coordination, and management of an individual’s waiver (such as LTSS/ IDD), and BH or PH needs. Uses tools an...
Search Terms: English, Spanish, Bilingual, Coordinator, Service
0
0mi
Updated: September 20
Network Relations Consult Sr (US)-1
MIAMI, 11430 NW 20TH ST, STE 300
Develops and maintains positive provider relationships with provider community by regular on-site visits, communicating administrative and programmatic changes, and facilitating, education and the resolution of provider issues. Serving as a knowledge and resource expert regarding the most complex pro...
Search Terms: Relations, Network, Healthcare, Business Services
0
0mi
Updated: September 20
Investigator II - Carelon Payment Integrity SIU
MIAMI, 11430 NW 20TH ST, STE 300
Claim reviews for appropriate coding, data mining, entity review, law enforcement referral, and use of proprietary data and claims systems for review of facility, professional, and pharmacy claims. Responsible for identifying and developing enterprise-wide specific healthcare investigations that may ...
Search Terms: Investigator, Payment, Integrity, Healthcare, Business Services
0
0mi
Updated: September 20
LTSS Service Coordinator - Clinician
MIAMI, 7235 NW 19TH ST, STE E
LTSS Service Coordinator - Clinician. Location: This is a field based position, candidate would need travel in and around the following counties based on their current location, Lee, Sarasota, Palm Beach, St. Lucie, Broward, and Miami-Dade counties, FL. The LTSS Clinician works under the direction/su...
Search Terms: Clinician, Coordinator, Service, RN, Clinic
0
0mi
Updated: September 20
Commercial Credit Underwriter
Miami
Perform underwriting of new and existing commercial real estate, commercial & industrial loans, mostly for complex requests, to assess the financial condition, repayment capacity, and risks associated with the transaction. Perform real estate cash flow analysis, global cash flow analysis, and assess ...
Search Terms: Commercial, Underwriter, Writer, Credit, Skills
0
0mi
Updated: September 20
Client Care Manager (Call Center Manager)
Miami
Responsible for the Key Performance Indicators (KPI's) of the call center establishing metrics to measure the production of the call center agents and proposing an action plan to close the gaps/deficiencies reviewing the effectiveness of the KPI's on a periodic basis. Responsible for developing objec...
Search Terms: Manager, Call Center, Care Manager, Client, Project Management
0
0mi
Updated: September 20
Ramp & Warehouse On call Agents
Miami
Assist with the sorting, loading and unloading of our Customer's shipments; ensuring that they are handled and stored with care, safely and efficiently Complete training in the use the equipment to get the job done in a safe and efficient manner (i.e. forklifts, handheld scanners, Tugs, K-Loaders) Op...
Search Terms: Warehouse, Agent, Manufacturing
0
0mi
Updated: September 20
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