- Actalent (Sunrise, FL)
- …Utilization management + Interqual + Milliman Commercial Guidelines + Medicaid + Medical management + Medicare + Managed care + Patient care + Medical record ... Utilization Management Nurse!Job Description The Utilization Management ...including InterQual and Milliman Criteria, Florida Medicaid Program, and CMS Guidelines. + Knowledge of community and post-acute resources… more
- Elevance Health (Miami, FL)
- … Medicare Administrative Contract (MAC) with the federal government (The Centers for Medicare and Medicaid Services ( CMS ) division of the Department of Health ... member of Elevance Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services… more
- Humana (Tallahassee, FL)
- …community and help us put health first** The Encounter Data Management Professional develops business processes to ensure successful submission and reconciliation ... of encounter submissions to Medicaid/ Medicare . Ensures encounter submissions meet or exceed all compliance standards via analysis of data, and develops tools to… more
- Molina Healthcare (Jacksonville, FL)
- …Google or Adobe analytics (or similar) Google AdWords, Tag Manager systems, (Adobe or Google) CMS ( content management system ) Google Ads SEO, SEM, CRM ... and incorporate learnings to drive continuous improvements + Create promotional and content strategies to expand digital reach + Collaborate on developing content… more
- AdventHealth (Altamonte Springs, FL)
- …and forecast upcoming regulatory and public-reporting trends such as Centers for Medicare and Medicaid Services ( CMS ) Value-Based Purchasing, Agency for ... **GENERAL SUMMARY** **:** The Vice President of Quality serves as the health system expert and executive sponsor with responsibility for developing and executing a… more
- BAYADA Home Health Care (Jacksonville, FL)
- …home health agency preferred but not required Comprehensive knowledge of Medicare regulations, OASIS documentation, HIPAA, and CMS guidelines. Proficiency ... experienced and compassionate **Director** to manage operations at our **Jacksonville, FL Medicare -certified Home Health office** . The ideal candidate will have a… more
- Convey Health Solutions (Fort Lauderdale, FL)
- …enrollment applications and disenrollment forms for correction and submission to Centers for Medicare & Medicaid Services ( CMS ) + Review and complete Late ... Data Validation file and submissions All Functions + Working understanding of Centers for Medicare & Medicaid Services ( CMS ) guidance + Conform with and abide by… more
- CVS Health (Tallahassee, FL)
- …researching and resolving Medicare complaints received via the Centers for Medicaid and Medicare Services ( CMS ). In this role, you will manage a queue of ... Medicare knowledge/experience + Prior experience with complaints and/or Center for Medicare and Medicaid Services ( CMS ) + Medical/RX claim processing… more
- Ensono (Miami, FL)
- …Interchange (EFI), Next Generation Desktop (NGD), Electronic File Interchange (EFI), and the CMS Identity Management System (IDM). **Why Ensono?** Ensono is ... and FIPS 140-2, as applicable. + Maintain and renew certifications required for system access and management , ensuring continued compliance and eligibility. +… more
- Intermountain Health (Tallahassee, FL)
- …the quality performance of government-sponsored healthcare programs, with a primary focus on Medicare and CMS Star Ratings. This position is responsible for ... initiatives, particularly around key measures such as medication adherence, Medication Therapy Management (MTM), and Statin Use in Persons with Diabetes (SUPD). A… more