- Healthfirst (FL)
- …of at least two or more lines of business such as Medicare NY/NJ, Medicaid , Family Health Plus, Child Health Plus, NH Family + Experience managing a Quality ... Assurance or Operations Audit team. + Experience working with AI or other machine learning tools to assist with streamlining QA processes. + Experience working with delegates/vendors in a healthcare insurance setting. + Demonstrated experience or deep… more
- WestCare Foundation (Miami, FL)
- …reviews + Document all clinical services and activities in accord with licensing, Medicaid , and Joint Commission standards and agency policy and procedure + Conduct ... individual case management sessions + Provide vocational education and skills building to the consumer as needed + Perform activities on behalf of the consumer and family, including attendance at external appointments (eg, court appearances, school staffing,… more
- HCA Healthcare (St. Petersburg, FL)
- …You will maintain a thorough working knowledge of the rules of Medicare, Medicaid , and private payer regulations and processes. You will possess a thorough ... understanding of managed-care concepts and length-of-stay management relating to patient and organizational fiscal responsibility. + You will perform thorough assessments and develop appropriate discharge plans for high-risk patients with discharge planning or… more
- BrightSpring Health Services (Sarasota, FL)
- …federal and state law requirements and conditions of participation for Medicare and Medicaid are met. + Gather data for assigned area(s) and prepare written reports. ... Use the collected data to identify and areas of concern and implement quality improvement plans to address the concerns. + Respond in writing or verbally to client or community concerns, audit requests, and/or contract complaints regarding quality of services… more
- Aveanna Healthcare (Melbourne, FL)
- …any time with or without notice. As an employer accepting Medicare and Medicaid funds, employees must comply with all health-related requirements in all relevant ... jurisdictions, including required vaccinations and testing, subject to exemptions for medical or religious reasons as appropriate. Notice for Job Applicants Residing in California (https://www.aveanna.com/CaliforniaPrivacyNotices.html) Apply more
- AdventHealth (Sebring, FL)
- …but not limited to: Coordination of Care, Centers for Medicare & Medicaid Services (CMS) Conditions of Participation, Social Services implementation of processes ... based upon data management, accountability for Length of Stay, Excess Days, Avoidable Days, Readmission Prevention, and Discharge Planning. In addition, the Care Management Manager is responsible for department engagement, customer experience, compliance of… more
- Molina Healthcare (Tampa, FL)
- …Guidelines, MCG, InterQual or other medically appropriate clinical guidelines, Medicaid , Medicare, CHIP and Marketplace, applicable State regulatory requirements, ... including the ability to easily access and interpret these guidelines. **Required License, Certification, Association** Active, unrestricted State Registered Nursing (RN) license in good standing. **Preferred Education** Bachelor's Degree in Nursing… more
- Evolent (Tallahassee, FL)
- …or sanction by any state or federal health care program, including Medicare or Medicaid , and is not identified as an "excluded person" by the Office of Inspector ... General of the Department of Health and Human Services or the General Service Administration (GSA), or reprimanded or sanctioned by Medicare. + No history of a major disciplinary or legal action by a state medical board **To comply with HIPAA security… more
- Public Consulting Group (Tallahassee, FL)
- …support the delivery of health-related services by helping schools access critical Medicaid reimbursement. Client Success Partners (CSP) are key members of the ... Client Success Team within the School Based Services (SBS) Center of Excellence (COE). This role will directly work with PCG Education clients, taking ownership for stakeholder engagement with a strong focus on optimizing program returns. This role must… more
- HCA Healthcare (Fort Pierce, FL)
- …You will maintain a thorough working knowledge of the rules of Medicare, Medicaid , and private payer regulations and processes. You will possess a thorough ... understanding of managed-care concepts and length-of-stay management relating to patient and organizational fiscal responsibility. + You will perform thorough assessments and develop appropriate discharge plans for high-risk patients with discharge planning or… more