- BAYADA Home Health Care (Orlando, FL)
- …while using the Medicare PDGM billing model and CMS guidelines. + Review and communicate OASIS edit recommendations to each clinician to promote OASIS accuracy. ... Home Health Care is hiring a full time OASIS Review and Coding Manager. The OASIS and Coding ...review . + Knowledge of OASIS, Home Care and Medicare regulations + Excellent organizational, interpersonal and communication skills… more
- Humana (Tallahassee, FL)
- …group practice management + Utilization management experience in a medical management review organization, such as Medicare Advantage and managed Medicaid + ... other sources of expertise. The Behavioral Health Medical Directors will learn Medicare , Medicare Advantage and Medicaid requirements, and will understand how… more
- Humana (Tallahassee, FL)
- …and Managed Medicaid. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or ... teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements and will understand how to… more
- Humana (Tallahassee, FL)
- …medical directors and leadership during Medicare and Medicaid LOB - Medicare Clinical Criteria Review (MCCR), Utilization Management Committee (UMC), Medical ... develop and maintain medical coverage policies utilizing an evidence based medicine review process. **Location:** work at home anywhere Humana is seeking a Senior… more
- AdventHealth (Altamonte Springs, FL)
- …positions taken on the hospital cost report, or other required reporting + Review the Medicare and Medicaid Uniform Contractual Worksheet-Third Party Settlement ... activities. These activities include preparation and filing the annual Medicare , Medicaid, and Champus/Tricare cost reports; preparation of reopening and… more
- St. George Tanaq Corporation (Tallahassee, FL)
- …Requirements **Required Experience and Skills** + One (1) year of Medicare appeals, medical review , clinical, healthcare regulatory interpretation/application, ... college or university in healthcare or related discipline Additional experience in Medicare appeals, medical review , clinical, or other related experience in… more
- Humana (Palm Bay, FL)
- …caring community and help us put health first** Are you passionate about the Medicare population, looking for an opportunity to work in sales, and wanting the ... through service, organizations, activities and volunteerism + Experience selling Medicare products + Bilingual with the ability to speak,...and therefore subject to driver license validation and MVR review . + Any Humana associate who speaks with a… more
- Elevance Health (Tampa, FL)
- …for Medicare fee for service and assisting nurses as needed with review of claims. Works with other Medicare Administrative Contractor (MAC) Medical ... **Medical Director- Medicare Fee for Service** Location: This role enables...collaborative policies. May participate in MAC policy workgroups to review coverage criteria for existing services or new services… more
- Prime Therapeutics (Tallahassee, FL)
- …our passion and drives every decision we make. **Job Posting Title** Mgr Medicare Part D Pharmacy Programs - Remote, Pennsylvania **Job Description** Manages the ... coordination of benefits in the pharmacy program with Medicare Part D plans. Provides the technical and leadership...$74,000.00 - $118,000.00 based on experience and skills. To review our Benefits, Incentives and Additional Compensation, visit our… more
- Molina Healthcare (Jacksonville, FL)
- …Summary** Responsible for leading, organizing and directing the activities of the Medicare Contracted Provider Post-Pay Claim Appeals and Disputes in accordance with ... the standards and requirements established by the Centers for Medicare and Medicaid. **Knowledge/Skills/Abilities** * Leads, organizes, and directs the activities of… more