- HCA Healthcare (Tallahassee, FL)
- …safety compliance. The role provides oversight for matters including the Centers for Medicare and Medicaid Services ( CMS ), The Joint Commission (TJC), state ... the HCA Regulatory and Accreditation Team. + Establishes and maintains proactive system for continual survey readiness with division and facility key stakeholders… more
- Actalent (Sunrise, FL)
- …Utilization management + Interqual + Milliman Commercial Guidelines + Medicaid + Medical management + Medicare + Managed care + Patient care + Medical record ... Utilization Management Nurse!Job Description The Utilization Management ...including InterQual and Milliman Criteria, Florida Medicaid Program, and CMS Guidelines. + Knowledge of community and post-acute resources… more
- Actalent (Sunrise, FL)
- …Utilization management + InterQual + Milliman Commercial Guidelines + Medicaid + Medical management + Medicare + Managed care + Patient care + Medical record ... Actalent is hiring a Utilization Management Nurse! Job Description The Utilization Management...Milliman Criteria. + Knowledge of Florida Medicaid Program and CMS Guidelines. + Proficient in word processing software, spreadsheet… more
- Molina Healthcare (Jacksonville, FL)
- **Job Description** **Job Summary** Molina Pharmacy Services/ Management staff work to ensure that Molina members, providers, and pharmacies have access to all ... members, providers, pharmacists, pharmacies, and technicians to meet departmental and CMS standards. + Enforce HIPAA compliance standards and regulations while… more
- BayCare Health System (Sarasota, FL)
- … and awarded the government's highest 5-Star rating for quality by the Centers for Medicare & Medicaid Services ( CMS ), is seeking for its newest full time Home ... Health Registered Nurse in beautiful North Port, FL. The Home Health RN provides hands-on care in the home for a group of patients consistently using the nursing process and clinical standards and protocols. + **Facility:** Sarasota Memorial HomeCare +… more
- AdventHealth (Sebring, FL)
- …is responsible for, but not limited to: Coordination of Care, Centers for Medicare & Medicaid Services ( CMS ) Conditions of Participation, Social Services ... and hiking trails **The role you'll contribute:** The Care Management Manager is under the general leadership of the...Manager is under the general leadership of the Care Management Facility Director and has the responsibility of the… more
- Molina Healthcare (Tampa, FL)
- …Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + Identifies and reports ... be required. + Serves as a clinical resource for Utilization Management , Chief Medical Officer, Physicians, and Member/Provider Inquiries/Appeals. + Provides… more
- AdventHealth (Daytona Beach, FL)
- …is responsible for, but not limited to: Coordination of Care, Centers for Medicare & Medicaid Services ( CMS ) Conditions of Participation, Social Services ... Daytona Beach, 32117 **The role you'll contribute:** The Care Management Manager is under the general leadership of the...Manager is under the general leadership of the Care Management Facility Director and has responsibility of the departmental… more
- BayCare Health System (Clearwater, FL)
- …| Exempt | Reimbursement Department **About the Role:** The Senior Revenue Management Analyst plays a key role in BayCare's Reimbursement department, specializing in ... the Team:** + Analyze government reimbursement data and develop strategies for Medicare /Medicaid Cost Reports + Prepare and review annual cost reports and ensure… more
- AdventHealth (Davenport, FL)
- … department, including but not limited to: Coordination of Care, Centers for Medicare & Medicaid Services ( CMS ) Conditions of Participation, Discharge Planning, ... in the central hub of tourism. **The role you'll contribute:** The Care Management Facility Director has full accountability and oversight for the overall operations… more