- 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
- CenterWell (Tallahassee, FL)
- …our caring community and help us put health first** The Program Management Lead, Offshore Coding Operations conducts quality assurance audits of medical ... for Medicare and Medicaid Services ( CMS ) and other government agencies. The Program Management Lead, Offshore Coding Operations works on problems of diverse… more
- Molina Healthcare (Orlando, FL)
- …length of stay and level of care provided to members. Contributes to overarching strategy to provide quality and cost-effective member care. Candidates with UM ... Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ)… more
- Oracle (Tallahassee, FL)
- …Intelligence Organization. This team will focus on product development and product strategy for Oracle Health, while building out a complete platform supporting ... **What You'll Do** As a member of the Hospital Quality Reporting team, you will use basic knowledge of...that run in our clients EHR (Electronic Health Record) system to enable our clients' to track compliance with… more
- NBC Universal (Orlando, FL)
- …the day-to-day incorporation of high- quality automation of processes, develops, quality engineering, and release management , cloud into every-day work. ... front-end experiences. This role is focused on delivery and support of quality , high-end, best-in-class experiences for our guests and business partners. This role… more
- CenterWell (Tallahassee, FL)
- …with prior experienceparticipatingin teams focusing on transitions of care, quality management ,utilizationmanagement, case management , discharge planning ... to innovate. **Additional Information** Will report to the Director of Physician Strategy at Utilization Management . The Medical Director conducts Utilization… more
- Convey Health Solutions (Fort Lauderdale, FL)
- …Vice President, Risk Solutions. KEY DUTIES AND RESPONSIBILITIES: + Lead Product Strategy : Define and execute the roadmap for the Medicare Advantage Risk Adjustment ... + Regulatory Compliance: Ensure all products, processes, and activities comply with CMS (Centers for Medicare & Medicaid Services) regulations, as well as other… more
- Humana (Tallahassee, FL)
- …of mandated reports, leveraging their understanding of claims data and Medicaid program requirements to drive accurate and timely submissions. The Senior Data and ... data from multiple sources to produce requested or required data elements. Programs and maintains report forms and formats, information dashboards, data generators,… more
- Elevance Health (Tampa, FL)
- …management for these markets. May be responsible for developing and implementing programs to improve quality , cost, and outcomes. May provide clinical ... + Provides guidance for clinical operational aspects of a program . + Perform utilization management reviews to...of care, using nationally recognized criteria (eg, MCG, InterQual, CMS guidelines). + Collaborate with UM nurses and case… more
- Molina Healthcare (Miami, FL)
- …and appeals. * Records calls accurately within the pharmacy call tracking system . * Maintains established pharmacy call quality and quantity standards. ... calls from members, providers, and pharmacies. Contributes to overarching pharmacy strategy for optimization of medication related health care outcomes, and … more