- AgeWell Solvere Living (North Palm Beach, FL)
- …heads, as needed, to ensure policies and procedures are implemented and regulatory compliance is maintained. Successful candidates will possess strong ... care and the regulations of the state's nursing commission; ensures and maintains regulatory compliance with all such regulations Assists in the coordination and… more
- Pyramid Consulting, Inc. (Thonotosassa, FL)
- …audit score of 90% minimum. 80-120 calls/day to Medicare population. 100% compliance required of all assigned members. Completion of 600 members/month requirement ... ensure standards of practice and policies are in accordance with state and regulatory requirements and provide to providers as needed. Knowledge of existing benefits… more
- Molina Healthcare (Miami, FL)
- …Degree in Healthcare Administration **Preferred Experience** + 10 years of managed care experience ( Regulatory and Compliance ) + Previous management ... Administration such as oversight, audit, etc. **Required Experience** * 7 years of managed care experience ( Regulatory and Compliance ) * Previous management… more
- Molina Healthcare (Miami, FL)
- …dynamics, and the latest Medicaid trends, positioning Molina as a leader in Medicaid managed care + Track regulatory compliance and address any operational ... and experience + 7 years in market strategy, business development, or healthcare consulting, specifically within Medicaid managed care or equivalent related… more
- Molina Healthcare (Jacksonville, FL)
- …environment. * 3+ years experience in provider contract negotiations in a managed healthcare setting ideally in negotiating different provider contract types, ... group and hospital contracting, etc. * Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and… more
- Molina Healthcare (St. Petersburg, FL)
- …review. The position may also work with other internal departments, including Compliance , Corporate Legal Counsel, and Medical Officers in order to achieve and ... various internal customers (eg, Provider Services, Contracting and Credentialing, Healthcare Services, Member Services, Claims) to gather documentation pertinent to… more
- HCA Healthcare (Lake City, FL)
- …and policies and procedures. Ensure compliance with quality patient care and regulatory compliance . + Ensures compliance with all regulatory ... on years of service) + Employee Stock Purchase Plan with 10% off HCA Healthcare stock + Family support through fertility and family building benefits with Progyny… more
- Molina Healthcare (St. Petersburg, FL)
- …+ Review Medicaid COB claims for correct secondary pricing logic and compliance with configuration and regulatory rules. + Analyze claim outcomes ... our Payment Integrity and Claims Operations teams in ensuring the accuracy and compliance of Coordination of Benefits (COB) claim pricing and processing. This role… more
- Molina Healthcare (Orlando, FL)
- …appropriate and correct clinical decisions for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) ... knowledge, knowledge of all relevant and applicable Federal and State regulatory requirements and guidelines, knowledge of Molina policies and procedures, and… more
- Molina Healthcare (Jacksonville, FL)
- …that support continuous quality improvement of the provider database, compliance with regulatory /accreditation requirements, and Network Management business ... equivalent combination of education and experience **Required Experience** + 3-5 years managed care experience, including 2+ years in Provider Claims and/or Provider… more
