- Molina Healthcare (Miami, FL)
- …SLAs (Service Level Agreements) + Utilize critical thinking skills to proactively communicate eligibility issue trends with Management . + Manages high volumes of ... The Sr Rep, Enrollment handles all processes related to membership eligibility inquiries and ensures membership accuracy within the system. Represents Enrollment… more
- Actalent (Sunrise, FL)
- …review + Utilization management + Interqual + Milliman Commercial Guidelines + Medicaid + Medical management + Medicare + Managed care + Patient care ... Utilization Management Nurse!Job Description The Utilization Management ...utilization review concepts, including InterQual and Milliman Criteria, Florida Medicaid Program, and CMS Guidelines. + Knowledge of community… more
- MyFlorida (Miami, FL)
- …subtleties of group dynamics. This position with APD will serve staff and management across the Agency. Your work will impact the workplace culture, our community, ... Analyst (intake) is responsible for maintaining intake caseload to determine APD eligibility . Consults with individuals, families and others regarding the APD … more
- CVS Health (Miami, FL)
- …Special Needs Plan (DSNP) members, who are enrolled in both Medicare and Medicaid and face a variety of complex health and social challenges. Through compassionate ... locations, medical facilities, and other locations. + Completing care management focused assessments. + Setting member-centered goals. + Identifying barriers… more
- BeneLynk (Sunrise, FL)
- …of the role will include making and fielding calls to help Medicare and Medicaid Managed Care Plan Members determine which benefit(s) best suit them and assisting ... Community Programs (transportation, meals, energy discounts), Medicare Savings Programs, Medicaid , and Veteran's coordination of care. Our outstanding Member… more
- CVS Health (Tallahassee, FL)
- …expertise in healthcare and information technology to ensure efficient data management , promote data-driven insights, and enhance the delivery of healthcare services ... * Support Medicaid markets on analysis of key improvement activities and...and interventions, including analyzing for intervention effectiveness * Leads management of the quality data, reporting, and analytics function… more
- CVS Health (Tallahassee, FL)
- …three years of relevant work experience or + Three years' experience in practice management or an administrative leadership role in primary care setting or + Three ... of HEDIS and Pay for Performance metrics, ICD-10 coding, Medicaid risk adjustment methodology, and common billing and common...work experience or + Three years' experience in practice management or an administrative leadership role in primary care… more
- MyFlorida (Tallahassee, FL)
- …rules, policies, procedures, and processes which affect decisions and determinations of eligibility for care and management of the client's medical needs. ... to, core members of the CMAT team, the client's Medicaid Managed Medical Assistance (MMA) plan and Agency for...in the multidisciplinary team process to determine medically necessary eligibility for long-term care services of MFC, SNF and… more
- Elevance Health (FL)
- …performing complex actuarial studies related to risk adjustment analytics in both the Medicaid and Medicare Advantage lines of business. **How You Will Make an ... limited to: + Analyzes and develops SAS and SQL programming to support Medicaid and Medicare Advantage risk adjustment initiatives. + Performs data mining and… more
- MyFlorida (Daytona Beach, FL)
- …correct insurance and processes all claims accordingly. Researches claims for Medicaid , Medicare and other third party insurance. Contacts insurance carriers when ... for CPT and ICD codes or accuracy. Maintains a working knowledge of Medicaid , Medicare and various insurance billing policies, which includes but is not limited… more