• RN Lead, HCS (Clinical) Remote with field travel…

    Molina Healthcare (St. Petersburg, FL)
    …that involve clinical HCS staff. Communicates findings to the Supervisor or Manager , HCS Department for resolution. + Maintains a minimal caseload as determined ... guidelines and support staff who have an ongoing member case load for regular outreach and management. + As...staff workload for adherence to the Policies, Procedures, Guidelines, Medicare Model of Care, and deadlines. Assures oversight and… more
    Molina Healthcare (08/15/25)
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  • Social Worker MSW PRN

    HCA Healthcare (Fort Walton Beach, FL)
    …patients with discharge planning or psychosocial needs. + Obtains input from the RN case manager to ensure the discharge plan is appropriate and aligns with ... maintains a thorough working knowledge of the rules of Medicare , Medicaid, and private payer regulations and processes, and...do in this role: + Works collaboratively with RN case managers, acute care nurses, physicians, insurance companies, and… more
    HCA Healthcare (08/08/25)
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  • Director of Care Management FT Days

    AdventHealth (Minneola, FL)
    …including but not limited to: Coordination of Care, Centers for Medicare & Medicaid Services (CMS) Conditions of Participation, Discharge Planning, Social ... of Stay, Excess days, Avoidable Days, Value Based Care partnerships, Care Manager 's roles in Multidisciplinary Rounds, Care Transitions, team member engagement, team… more
    AdventHealth (08/23/25)
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  • Pharmacy Fulfillment Coordinator

    Humana (Miramar, FL)
    …consistently + Communicates and coordinates referrals with outside sources, such as case : managers, nursing agencies and Dr's offices personnel + Assists the ... and business needs + Additional responsibilities as assigned by the manager or Pharmacist-In-Charge **Regulatory Requirements** + One (1) year related pharmacy… more
    Humana (08/29/25)
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  • Primary Care Physician

    ChenMed (Kenneth City, FL)
    …mission-driven, primary care organization, is currently one of the most successful full-risk Medicare Advantage providers in the nation and has a vision to be ... PCP will engage with the transitional care team and others including case managers, acute and transitional-care physicians, and other resources that may be… more
    ChenMed (08/28/25)
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  • Primary Care Physician

    ChenMed (Bradenton, FL)
    …mission-driven, primary care organization, is currently one of the most successful full-risk Medicare Advantage providers in the nation and has a vision to be ... PCP will engage with the transitional care team and others including case managers, acute and transitional-care physicians, and other resources that may be… more
    ChenMed (08/28/25)
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  • Care Coordination Assistant

    BayCare Health System (Sarasota, FL)
    …Assistant will work under the direction of the Care Transition Coordinator or RN Case Manager to establish and maintain a positive working relationship with ... insurance, and benefit information. + Verifying insurance and benefits for all Medicare , Managed Care and Private Fee for Service Plans. Securing authorization for… more
    BayCare Health System (08/22/25)
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  • Utilization Review Nurse

    Actalent (Sunrise, FL)
    …utilization. Working under the general supervision of the Director and/or Manager /Supervisor of Medical Management, and in collaboration with an interdisciplinary ... management + Interqual + Milliman Commercial Guidelines + Medicaid + Medical management + Medicare + Managed care + Patient care + Medical record Additional Skills &… more
    Actalent (08/21/25)
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  • Clinical Appeals Nurse (RN)

    Molina Healthcare (Tampa, FL)
    …unrestricted Certified Clinical Coder + Certified Medical Audit Specialist + Certified Case Manager + Certified Professional Healthcare Management + Certified ... MCG, InterQual or other medically appropriate clinical guidelines, Medicaid, Medicare , CHIP and Marketplace, applicable State regulatory requirements, including the… more
    Molina Healthcare (08/15/25)
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  • Coding Auditor Educator

    Highmark Health (Tallahassee, FL)
    …system entities in response to external coding audits conducted by the Medicare Administrative Contractor, the RAC, MIC, ZPIC, etc. Determine appeal action, prepare ... works with external resources to create and monitor inpatient case mix reports and the top 25 assigned DRGs/APCs...related to special projects and providing coverage for coding manager (s). (10%) + Depending on location provides or arranges… more
    Highmark Health (08/08/25)
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