- Molina Healthcare (Jacksonville, FL)
- …building regulatory compliance audit procedures. * At the direction of management , coordinates and performs oversight audits and validation activities to ensure ... other evidence as part of regulatory audits. EX: DMHC, CMS active audits. Responsible for acting as the liaison...Provides draft written reports of audits and findings to management , including recommendations for any identified finding; Supports … more
- Elevance Health (Tampa, FL)
- … Medicare Administrative Contract (MAC) with the federal government (The Centers for Medicare and Medicaid Services ( CMS ) division of the Department of Health ... member of Elevance Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services… more
- Humana (Tallahassee, FL)
- … management + Utilization management experience in a medical management review organization such as Medicare Advantage, managed Medicaid, or Commercial ... health first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments involve… more
- Molina Healthcare (Jacksonville, FL)
- …Google or Adobe analytics (or similar) Google AdWords, Tag Manager systems, (Adobe or Google) CMS ( content management system ) Google Ads SEO, SEM, CRM ... and incorporate learnings to drive continuous improvements + Create promotional and content strategies to expand digital reach + Collaborate on developing content… more
- Humana (Tallahassee, FL)
- …and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home health, SNF, DME, dual ... Medicare /Medicaid and Waiver requests. The Medical Director provides medical...other healthcare professionals are in agreement with national guidelines, CMS requirements, Humana policies, clinical standards, and (in some… more
- BAYADA Home Health Care (Jacksonville, FL)
- …home health agency preferred but not required Comprehensive knowledge of Medicare regulations, OASIS documentation, HIPAA, and CMS guidelines. Proficiency ... experienced and compassionate **Director** to manage operations at our **Jacksonville, FL Medicare -certified Home Health office** . The ideal candidate will have a… more
- Convey Health Solutions (Fort Lauderdale, FL)
- …enrollment applications and disenrollment forms for correction and submission to Centers for Medicare & Medicaid Services ( CMS ) + Review and complete Late ... Data Validation file and submissions All Functions + Working understanding of Centers for Medicare & Medicaid Services ( CMS ) guidance + Conform with and abide by… more
- AdventHealth (Altamonte Springs, FL)
- …and forecast upcoming regulatory and public-reporting trends such as Centers for Medicare and Medicaid Services ( CMS ) Value-Based Purchasing, Agency for ... **GENERAL SUMMARY** **:** The Vice President of Quality serves as the health system expert and executive sponsor with responsibility for developing and executing a… more
- Humana (Tallahassee, FL)
- …team to assist and facilitate new hires and remediation of medical directors performing Medicare utilization management processes and be the liaison for the ... key enterprise leader, with responsibility for evolving Humana's Utilization Management of medical review by physician or nurse, with...or nurse, with a focus on our 5+ million Medicare members. You will also facilitate the delivery of… more
- BAYADA Home Health Care (Orlando, FL)
- …for quality and adherence to policies and procedures. As a member of the Medicare Case Management (MCM) office, individuals in this role are expected to ... to the OASIS and ICD 10 coding while using the Medicare PDGM billing model and CMS guidelines. + Review and communicate OASIS edit recommendations to each… more