• Risk & Quality Performance Manager (Remote)

    Molina Healthcare (St. Petersburg, FL)
    …EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:** * 2+ years of program and/or project management experience in risk adjustment and/or quality * 2+ years of ... Plan Risk and Quality leaders to improve outcomes by managing Risk/ Quality data collection strategy , analytics, and reporting, including but not limited… more
    Molina Healthcare (09/19/25)
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  • STARS Strategy Advancement Lead

    Humana (Tallahassee, FL)
    …Healthcare Administration, related field, or any field + 7 years of experience in project management or program management in healthcare or a related field + ... Enterprise Stars Activation model to ensure Medicare Advantage Stars strategy is consistently embedded across all lines of business....other advanced degree + Experience with Medicare Advantage and CMS Stars programs with HEDIS, CAHPS, HOS,… more
    Humana (09/26/25)
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  • VP Quality AdventHealth Central Florida…

    AdventHealth (Altamonte Springs, FL)
    …expert and executive sponsor with responsibility for developing and executing a comprehensive quality management program that drives high-value care to ... Quality will be responsible for leading a comprehensive quality management program encompassing both... databases (Vizient, Premier, Quantros, etc) Experience with national quality programs (Leapfrog, CMS 5-Star,… more
    AdventHealth (08/07/25)
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  • Clinical Pharmacist - Collaborative Practice…

    ChenMed (Miami, FL)
    …identified as at risk for non-adherence to chronic medications, focusing on CMS quality measure drug classes (eg, diabetes, hypertension, cholesterol) and ... to optimize medication use, improve patient outcomes, and enhance CMS Star Ratings and HEDIS quality measures....immunization is a plus + Completion of Medication Therapy Management certificate program or Ambulatory Care Certificate… more
    ChenMed (08/16/25)
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  • Division Director of Regulatory and Accreditation

    HCA Healthcare (Tampa, FL)
    …will act as a resource for CMS regulatory and outcomes monitoring programs ; for federal reporting system (s); and for Joint Commission sentinel event ... As our new Director, you will be responsible for supporting the Division Quality and Clinical Operations strategy by coordinating activities related to… more
    HCA Healthcare (09/27/25)
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  • Audit & Reimbursement III (US)

    Elevance Health (Tampa, FL)
    …and Experiences** : + Degree in Accounting or Finance preferred. + Knowledge of CMS program regulations and cost report format preferred. + Knowledge of ... for Medicare and Medicaid Services to transform federal health programs . The **Audit and Reimbursement III** will support our...federal government (The Centers for Medicare and Medicaid Services ( CMS ) division of the Department of Health and Human… more
    Elevance Health (09/27/25)
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  • Audit & Reimbursement Senior

    Elevance Health (Miami, FL)
    …five years._** **Preferred Qualifications** : + Accounting degree preferred. + Knowledge of CMS program regulations and cost report format preferred. + Knowledge ... the Centers for Medicare and Medicaid Services to transform federal health programs . The **Audit and Reimbursement Senior** will support our Medicare Administrative… more
    Elevance Health (09/25/25)
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  • LVN Delegation Oversight Nurse Remote

    Molina Healthcare (St. Petersburg, FL)
    …other standards and requirements pertaining to delegation agreements. Contributes to overarching strategy to provide quality and cost-effective member care. This ... with preparation of delegation summary reports submitted to the Eastern US Quality Improvement Collaborative (EQIC) and/or utilization management committees. +… more
    Molina Healthcare (09/20/25)
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  • Safety, Quality and Patient Experience…

    Cleveland Clinic (Weston, FL)
    …a consultant in educating and evaluating clinical and support department staff regarding quality management regulations and standards of care. + Support medical ... Act as the primary resource for staff to facilitate overall operations of programs . + Develop meaningful quality assurance and improvement activities with… more
    Cleveland Clinic (09/10/25)
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  • Healthcare Services Operations Support Auditor

    Molina Healthcare (Miami, FL)
    …ensuring quality compliance and desired member outcomes. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job ... and written communication skills. * Microsoft Office suite/applicable software program (s) proficiency. Preferred Qualifications * Utilization management , care… more
    Molina Healthcare (09/28/25)
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