- Molina Healthcare (Jacksonville, FL)
- …oversight of processes that track, evaluate, and submit encounter deletions for Medicare Advantage, ACA, and Medicaid lines of business. This role has ... received from providers, improve completeness of encounter data with states, CMS , HHS to reconcile data. + Responsible for encounter submissions, rejection… more
- Humana (Tallahassee, FL)
- …or CMS guidelines, assessment and documentation practice + Case Management certification (CCM) + Bilingual in English and Spanish **Work-At-Home Requirements** ... Our nurses are titled Care Managers, because our case management services are centered on the person rather than...of the business day, primarily through an auto dialer system . Environment is fast paced and requires ability to… more
- Highmark Health (Tallahassee, FL)
- …leadership, problem-solving, data analytics, team development, communication, implementation, and project management . The incumbent often plays a central role in the ... include elements of team leadership, problem-solving, data analysis, project management , communication, implementation, and provider and/or provider-facing team education… more
- Humana (Tallahassee, FL)
- …data driven methods to develop and influence formulary strategies for Humana's Medicare line of business. + Utilizes broad understanding of pharmacy, managed care, ... pharmacy related field + Experience in Formulary strategy/development and CMS Part D guidance + Experience in analysis and...with staff in different positions and all levels of management positions. + Ability to prioritize, organizes, and executes… more
- Molina Healthcare (FL)
- …Action Items (SAIs) including assisting and executing projects and tasks to ensure CMS and State regulatory requirements are met for pre-pay edits, post payment ... and experience. + At least 3 years of Experience with Medicaid and/or Medicare . + Proven experience owning operational projects from concept to execution, especially… more
- University of Miami (Miami, FL)
- …HIPAA Notice of Privacy, No Surprise Billing, Good Faith Estimate, Off Campus Medicare Co-insurance and Advance Beneficiary Notices, and Medicare Secondary Payer ... requirements including but not limited to: OSHA, HIPAA, JC, AHCA, EMTALA, and CMS . The University of Miami offers competitive salaries and a comprehensive benefits… more
- AdventHealth (Altamonte Springs, FL)
- …residents + As the largest satellite campus within the AdventHealth system , AdventHealth Altamonte has been providing state-of-the-art healthcare to the community ... patient satisfaction, patient safety, readmission prevention and length of stay management . The RN Care Manager communicates daily with the interdisciplinary team… more
- CenterWell (Tallahassee, FL)
- …procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/ Medicare ... in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part… more
- HCA Healthcare (Orange Park, FL)
- …Advice + Payer denial/DRG downgrade letters + Complex NCD/LCD guidelines, CMS /AHCA policies and regulations + Federal Register, Center for Medicare ... Medicaid Services, American Hospital Association, Food and Drug Administration, Medicare Administrative Contractors and payer websites + Escalates problem… more
- University of Miami (Miami, FL)
- …funds. + Maintains appropriate records, files, and accurate documentation in the system of record. + Adheres to University and unit-level policies and procedures ... Privacy, No Surprise Billing, Good Faith Estimate, Off Campus Medicare Co-insurance and Advance Beneficiary Notices, and Medicare...not limited to: OSHA, HIPAA, JC, AHCA, EMTALA, and CMS . The University of Miami offers competitive salaries and… more