- CVS Health (Tallahassee, FL)
- …(if applicable) to ensure the ICD codes that are submitted to the Centers for Medicare and Medicaid Services ( CMS ) for the purpose of risk adjustment processes ... process audits to ensure compliance with internal policies and procedures and existing CMS regulations. + Ability to work independently as well as in a cross… more
- CenterWell (Tallahassee, FL)
- …DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/ Medicare ... in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part… more
- CenterWell (Tallahassee, FL)
- …procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/ Medicare ... in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part… more
- Molina Healthcare (Miami, FL)
- …to achieve operational goals and executes tasks and projects to ensure Centers for Medicare & Medicaid Services ( CMS ) and State regulatory requirements are met ... **Job Qualifications** **REQUIRED QUALIFICATIONS:** + Experience demonstrating knowledge of CMS Guidelines, MCG, InterQual or other medically appropriate clinical… more
- CVS Health (Tallahassee, FL)
- …of quality, sales effectiveness, retention, secret shopper initiatives, and state, federal, and CMS requirements for Medicare sales agents and programs + 0-3 ... and retain through the use of the Aetna IVL Medicare product portfolio.This role will deploy an operating model...integrated tech stack the call interactions, COIs, and lead management protocols with new and existing members. + Develop,… more
- AdventHealth (Sebring, FL)
- …is responsible for, but not limited to: Coordination of Care, Centers for Medicare & Medicaid Services ( CMS ) Conditions of Participation, Social Services ... and hiking trails **The role you'll contribute:** The Care Management Manager is under the general leadership of the...Manager is under the general leadership of the Care Management Facility Director and has the responsibility of the… more
- AdventHealth (Daytona Beach, FL)
- …is responsible for, but not limited to: Coordination of Care, Centers for Medicare & Medicaid Services ( CMS ) Conditions of Participation, Social Services ... Daytona Beach, 32117 **The role you'll contribute:** The Care Management Manager is under the general leadership of the...Manager is under the general leadership of the Care Management Facility Director and has responsibility of the departmental… more
- AdventHealth (Davenport, FL)
- … department, including but not limited to: Coordination of Care, Centers for Medicare & Medicaid Services ( CMS ) Conditions of Participation, Discharge Planning, ... in the central hub of tourism. **The role you'll contribute:** The Care Management Facility Director has full accountability and oversight for the overall operations… more
- AdventHealth (Tampa, FL)
- … department, including but not limited to: Coordination of Care, Centers for Medicare & Medicaid Services ( CMS ) Conditions of Participation, Discharge Planning, ... a well-balanced work life balance **The role you'll contribute:** The Care Management Facility Director has full accountability and oversight for the overall… more
- AdventHealth (Orlando, FL)
- …is responsible for, but not limited to: Coordination of Care, Centers for Medicare & Medicaid Services ( CMS ) Conditions of Participation, Social Services ... inpatients and 125,000 outpatients each year **The role you'll contribute:** **The Care Management Manager is under the general leadership of the Care Management … more