• Social Worker MSW

    HCA Healthcare (Tallahassee, 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
    HCA Healthcare (08/23/25)
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  • Care Manager, Registered Nurse - Field - Miami

    CVS Health (Coral Gables, FL)
    …Chronic Kidney Disease (CKD), post-acute care, hospice, palliative care, cardiac) with Medicare members + 2+ years care management, discharge planning and/or home ... health care coordination experience. + Candidate must have an active and unrestricted Florida Registered Nurse License (in good standing) within the region where job duties are performed + Ability to travel up to 50% within a designated geographic area for… more
    CVS Health (08/23/25)
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  • Executive Director Of Operations Specialty Care

    AdventHealth (Palm Coast, FL)
    …of performance with the State of Florida regulatory agencies, basic Centers for Medicare & Medicaid Services (CMS) regulations, as well as other local, state, and ... federal agencies, regulatory, and accrediting bodies and applicable policies and procedures. + OPERATING AND CAPITAL BUDGET/FISCAL RESPONSIBILITY: Ensures that all practices within scope of responsibility operate within allocated budget. Implements appropriate… more
    AdventHealth (08/23/25)
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  • Clinical Manager, Home Health

    CenterWell (Sarasota, FL)
    …audits/billing are completed timely and in compliance with Medicare regulations. + Coordinates communication between team members/attending physicians/caregivers ... to ensure the appropriateness of care and outcome planning. + Works in conjunction with the Branch Director and Company Finance Department to establish location's revenue and budget goals. + Participates in sales and marketing initiatives. + Supervises all… more
    CenterWell (08/23/25)
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  • Health Advocate- Call Coordinator, Healthy…

    CVS Health (Tallahassee, FL)
    …health advocacy team looking for dedicated friendly colleagues to help the Medicare population learn about and complete important health screenings and activities. ... As a Health Advocate on the Healthy Outcomes Team, you will interact with members telephonically to inspire healthy behaviors. Our goal on each call is to give every member a clear understanding of their benefits for specific screenings and medications. You… more
    CVS Health (08/23/25)
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  • Clinical Review Nurse - Prior Authorization

    Centene Corporation (Tallahassee, FL)
    …and determine medical necessity of service preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes ... preferred. **License/Certification:** + LPN - Licensed Practical Nurse - State Licensure required Pay Range: $26.50 - $47.59 per hour Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans,… more
    Centene Corporation (08/23/25)
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  • Director of Care Management FT Days

    AdventHealth (Minneola, FL)
    …including but not limited to: Coordination of Care, Centers for Medicare & Medicaid Services (CMS) Conditions of Participation, Discharge Planning, Social ... Services, Readmission Prevention, Length of Stay, Excess days, Avoidable Days, Value Based Care partnerships, Care Manager's roles in Multidisciplinary Rounds, Care Transitions, team member engagement, team member evaluations and customer experience. **The… more
    AdventHealth (08/23/25)
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  • Machine Learning Engineer

    CVS Health (Tallahassee, FL)
    …is a rapidly growing company of primary care centers for adults on Medicare in medically-underserved communities where there is little to no quality healthcare. Oak ... Street's care is based on an entirely new model that is based on value for its patients, not on volume of services. The company is accountable for its patients' health, spending more than twice as long with its patients and taking on the risks and costs of… more
    CVS Health (08/23/25)
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  • Marketing Automation Manager (Adobe AEP/NBA)

    Humana (Tallahassee, FL)
    …efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. ​ ... **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic… more
    Humana (08/23/25)
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  • Utilization Management Strategy Lead

    Humana (Tallahassee, FL)
    …efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. ​ ... **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic… more
    Humana (08/23/25)
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