- Molina Healthcare (Tampa, FL)
- …(CCM), Certified Professional Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ), or other health care certifications. + ... medically appropriate clinical guidelines. Contributes to overarching strategy to provide quality and cost-effective member care. This position will be supporting… more
- Molina Healthcare (Jacksonville, FL)
- …requirements/rules and are aligned with effective practices as identified in the healthcare quality improvement literature and within Molina plans. + Develops ... accurate billing and coding. This role also works with the Health Plan Risk/ Quality leaders to strategically plan for supplemental data source (SDS) acquisition from… more
- Molina Healthcare (Miami, FL)
- …Professional in Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ), Commission for Case Manager Certification (CCMC), ... care in the most effective setting. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties * Leads a team of… more
- Cleveland Clinic (Weston, FL)
- … experience + Certified Patient Safety Professional (CPPS) OR Certified Professional in Healthcare Quality (CPHQ) or willing to obtain within two years of ... include: + Master's degree + Registered Nurse (RN) + Certified Professional in Healthcare Quality (CPHQ) or willing to obtain within two years of hire +… more
- Community Health Systems (Key West, FL)
- …preferred **Knowledge, Skills and Abilities** + Strong understanding of healthcare quality measures, regulatory standards, and accreditation requirements. ... and/or Compact State Licensure required + CPHQ - Certified Professional in Healthcare Quality preferred Equal Employment Opportunity This organization does not… more
- Molina Healthcare (Miami, FL)
- …Pharmacy benefit management, Group/IPA practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management, ... Directors to standardized utilization management policies and procedures to improve quality outcomes and decrease costs. * Provide regional medical necessity reviews… more
- Humana (Miramar, FL)
- …BSN or bachelor's in health-related field preferred. + Minimum 4 years of healthcare quality experience, with strong knowledge of CMS Home Health regulations ... and help us put health first** The Home Health Quality Auditor ensures clinical documentation meets CMS regulations, OASIS...benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also… more
- Ascension Health (Pensacola, FL)
- …+ Quality Professional credentialed from the National Association for Healthcare Quality (NAHQ) preferred. + Risk Management preferred. Education: + ... Join Our Team** Ascension Sacred Heart is a leading provider of high- quality healthcare to children and adults in South Alabama and Northwest Florida communities… more
- CenterWell (Orlando, FL)
- …+ Proven work experience as a HEDIS Nurse or similar role in healthcare quality improvement + Excellent presentation and communication skills, both oral ... interpretation and independent determination of the appropriate courses of action. The Quality RN Professional collaborates with market leadership, and quality … more
- CenterWell (New Smyrna Beach, FL)
- …+ Proven work experience as a HEDIS Nurse or similar role in healthcare quality improvement + Strong knowledge of HEDIS/Stars/CMS + Excellent presentation ... Improvement Clinical Professional (RN): + Collaborates with market leadership, and quality improvement team to developand implement programs designed to increase the… more