- Surgery Care Affiliates (Tallahassee, FL)
- …class. + When the patient's insurance is Out of Network notify the manager immediately. Follow the Policies and Procedures when accepting Out of Network payers. ... + The Insurance Verifier will call each patient as part of center compliance with CMS Conditions for Coverage guidelines in contacting patient's prior to the… more
- CenterWell (Tallahassee, FL)
- …implementing quality improvement best practice initiatives designed to improve Medicare quality measures (HEDIS), patient safety and patient experience (CAHPS-HOS). ... assist with implementation of practice specific strategies designed to improve Medicare quality measures (HEDIS), patient safety and patient experience (CAHPS-HOS).… more
- Aveanna Healthcare (West Palm Beach, FL)
- …- $70,000.00 per year Position Details Position: Clinical Supervisor (RN) Clinical Case Manager Join a Company That Puts People First! Aveanna Healthcare is one of ... + Collaborate with the operations and business development team. + Ensure compliance with State, Federal, Local, and Aveanna policies and procedures. Qualifications… more
- Convey Health Solutions (Fort Lauderdale, FL)
- …applications and disenrollment forms for correction and submission to Centers for Medicare & Medicaid Services (CMS) + Review and complete Late Enrollment Penalty ... Monthly Reconciliation queues + Daily and Monthly Pharmacy Benefit Manager (PBM) + Monthly MMR, PWR, LIS History and...submissions All Functions + Working understanding of Centers for Medicare & Medicaid Services (CMS) guidance + Conform with… more
- CenterWell (Tallahassee, FL)
- …Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/ Medicare /Medicaid Experience a plus + Current nursing ... of home health services, and fourth largest pharmacy benefit manager , CenterWell is focused on whole-person health by addressing...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Molina Healthcare (FL)
- …quality member intervention initiatives including all lines of business ( Medicare , Marketplace, Medicaid). Executes health plan's member and community quality ... to identify opportunities for improvement + Surfaces to the Manager and Director any gaps in processes that may...skills. **PREFERRED QUALIFICATIONS:** + 1 year of experience in Medicare and in Medicaid managed care + Experience with… more
- CenterWell (Jacksonville, FL)
- …indicators (KPIs), such patient experience via Net Promoter Score (NPS) and Medicare clinical quality via HEDIS, meeting local and organizational goals + Personally ... care environment in a value-based relationship environment. + Knowledge of Medicare guidelines and coverage. + Knowledge of HEDIS quality indicators **Additional… more
- CenterWell (Tallahassee, FL)
- …quality and cost improvement for high-risk senior populations in full risk Medicare arrangements. This individual will help assess the value of each opportunity ... quality and value drivers in full risk care delivery, ideally in Medicare /seniors + Demonstrated ability to work collaboratively with clinical and operational… more
- CenterWell (Jacksonville, FL)
- …two to five years directly applicable experience preferred . Experience managing Medicare Advantage panel of patients with understanding of Best Practice in ... coordinated care environment in a value-based relationship environment . Knowledge of Medicare guidelines and coverage . Bilingual (English and Spanish) is a plus .… more
- Highmark Health (Tallahassee, FL)
- …drug benefit strategies, drug formularies, and programs specifically for the Medicare Advantage (MA) market. The incumbent will contribute to recommendations for ... and testing processes in partnership with the pharmacy benefits manager . The successful candidate will possess excellent communication, analytical, and… more