- 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
- Molina Healthcare (Tampa, FL)
- …the benefits, operations, communication, reporting, and data exchange of the Medicare /MMP product in support of strategic and corporate business objectives. Support ... for all Medicare lines of business the annual Medicare ...Marketing Guidelines, initiating HPMS submission of materials for CMS review when required. Provides oversight and update of the… more
- Humana (St. Augustine, FL)
- …exceed $113K depending on experience and location. 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
- St. George Tanaq Corporation (Tallahassee, FL)
- …Experience and Skills** + Must have 2-3 years of medical dispute resolution or Medicare appeals, medical review , clinical, or related experience in a healthcare ... college or university in healthcare or related discipline. Additional experience in Medicare appeals, medical review , clinical, or other related experience in… 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
- USAA (Tampa, FL)
- …seeking a talented **Life Special Investigations Unit Investigator I (Mid-Level)** to review , analyze, and investigate life, health, and annuity claims to ensure ... and other agencies as appropriate. As a Mid-Level Life SIU Investigator for ** Medicare Supplement Fraud, Waste, and Abuse** you will support the Life Special… more
- Molina Healthcare (Tampa, FL)
- …medical director, and quality improvement staff. + Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews quality referred ... timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial process. + Monitors appropriate...to practice and free of sanctions from Medicaid or Medicare . **PR** **E** **FE** **R** **RED ED** **U** **C**… more
- Molina Healthcare (Jacksonville, FL)
- …quality. **Job Duties** + Monitor and Evaluate Calls: Listen to and review Concierge call interactions to assess agent performance against quality standards, ... members, and manager. + Basic understanding of managed healthcare systems and Medicare . **PREFERRED EDUCATION:** Associate or bachelor's degree in social work, Human… more
- Elevance Health (Tampa, FL)
- ** Medicare Medical Director** Location: This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing ... Candidates must be able to work Eastern Time Zone hours. The ** Medicare Medical Director** is responsible for the administration of physical and/or behavioral… more
- Humana (Tallahassee, FL)
- …of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Represents Humana at Administrative ... established clinical experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be passionate about… more
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