- CVS Health (Tallahassee, FL)
- …Kidney Disease (CKD), post-acute care, hospice, palliative care, cardiac, home health with Medicare members + 2+ years case management, discharge planning and/or ... and healthcare personnel as appropriate. + Implements and coordinates all case management activities relating to catastrophic cases and chronically ill… more
- BAYADA Home Health Care (Orlando, FL)
- …for quality and adherence to policies and procedures. As a member of the Medicare Case Management (MCM) office, individuals in this role are expected to ... Manager provides support to all BAYADA Home Health Care Medicare service offices by monitoring Outcome and Assessment Information...the OASIS and ICD 10 coding while using the Medicare PDGM billing model and CMS guidelines. + Review… more
- Molina Healthcare (St. Petersburg, FL)
- …UM, Case Management, Claims, and other departments within Molina Medicare and Medicaid regarding A&G operations and dependencies. * Responsible for the ... Summary** Responsible for leading, organizing and directing the activities of the Medicare Duals Grievance and Appeals Unit that is responsible for reviewing and… more
- Humana (Tallahassee, FL)
- …other sources of expertise. The Behavioral Health Medical Directors will learn Medicare , Medicare Advantage and Medicaid requirements, and will understand how ... includes some experience in an inpatient environment and/or related to care of a Medicare or Medicaid type population + Current and ongoing Board Certification in an… more
- Humana (Tallahassee, FL)
- …teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements and will understand how to ... includes some experience in an inpatient environment and/or related to care of a Medicare type population (disabled or >65 years of age). + Current and ongoing Board… more
- Molina Healthcare (Tampa, FL)
- …and due-date logic * Proven history of building-or running-real-time dashboards that keep case aging within SLA * Demonstrated skill in root-cause triage that routes ... Quality, and Operations to fund high-return enhancements. **Core** ** ** **Duties** 1. Case Audits - Run scheduled and ad-hoc audits across internal and delegated… more
- Molina Healthcare (Orlando, FL)
- …the performance of prior authorization, inpatient concurrent review, discharge planning, case management and interdisciplinary care team activities. + Ensures that ... License without restrictions (free of sanctions from Medicaid or Medicare ) **PREFERRED EDUCATION:** Master's in Business Administration, Public Health, Healthcare… more
- CVS Health (Tallahassee, FL)
- …various life and work situations. + Appropriately documents member interactions and research/ case fulfillment in the system. + Works in an inbound and outbound ... + 1+ year(s) experience in social work, social services, or case management field. + Private, confidential workspace free from distractions.professional,… more
- CVS Health (Tallahassee, FL)
- …Director will provide clinical, coding, and reimbursement expertise as well as directing case management when necessary. The Medical Director will act as a business ... and clinical liaison to network providers and facilities if needed, to support the effective execution of medical services programs by the clinical teams. **Required Qualifications** *Two (2) or more years of experience in Health Care Delivery System eg,… more
- Humana (Tallahassee, FL)
- …+ Bachelor's degree. + Previous experience in utilization management. + Previous Medicare /Medicaid experience. + Previous case management experience. + Previous ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more