- Actalent (Sunrise, FL)
- …risk stratification, to determine health, psychological, educational, and social needs. + Review the daily census for enrollees admitted to the hospital, assess the ... and enrollees. + Participate in team huddles and multidisciplinary team conferences to review strategies and develop action plans for quality care. + Identify and… more
- Humana (Tallahassee, FL)
- …security architecture standards, and guiding engineering teams through the Technology Review Board and Architecture Review Board processes and participating ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- University of Miami (Miami, FL)
- …staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The ... + Assists in monitoring staff productivity and quality of work through proactive review of key performance indicators. + Serves as functional expert resource and… more
- Actalent (Sunrise, FL)
- …as necessary Skills: Quality improvement, data, audit, data abstraction, chart review , medical, quality audit, managed care, Medicare Work Environment: ... compare results to HEDIS standards and/or custom or other measure set standards + Review medical records and abstract data for HEDIS and other measure sets in… more
- CVS Health (Tallahassee, FL)
- …in concurrent audit initiatives based on resource requirements. Position conducts a review and ensures timely completion of inventory monitoring for each plan in ... oversight leadership and staff. Develops and supports thorough A&G inventory review and value analysis to determine selection, prioritization positioning and… more
- PCSI (Pensacola, FL)
- …supervisors and hourly employees. + Interview and hire the housekeeping staff, review job performance and recommend salary or status changes. + Conduct disciplinary ... interpret policies, procedures and regulations. + Ability to comply with Medicare , City, State, and Federal regulatory agency requirements. **Other Requirements:** +… more
- Convey Health Solutions (Miramar, FL)
- …knowledgebase, policies and procedures for consistency and increased productivity. + Review tickets daily for accuracy, policy adherence, and feedback opportunities. ... + Develop, review , and distribute IT reports and metrics. + Support...in providing integrated solutions for government-sponsored health plans, including Medicare , Medicaid, and commercial plans. The company focuses on… more
- Molina Healthcare (Orlando, FL)
- …Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, or other ... MCG, InterQual or other medically appropriate clinical guidelines, Medicaid, Medicare , CHIP and Marketplace, applicable State regulatory requirements, including the… more
- HCA Healthcare (Tampa, FL)
- …leadership + Works with team members in billing, revenue integrity and/or the Medicare Service Center to resolve alerts/edits + Assigns interim DRGs for in-house ... 2 Job Description + Periodically works with their manager to review individual work accomplishments, discuss work problems/barriers, discuss progress in mastering… more
- HCA Healthcare (Tamarac, FL)
- …and continued stay and discharge criteria. Orientation will also include Medicare and insurance benefits, grievance procedures, treatment plan process, and rights ... hospital nursing experience required + Certification in case management or utilization review preferred + InterQual experience preferred Founded in 1974, HCA Florida… more