- Molina Healthcare (Tampa, 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 (Atlantis, FL)
- …implement and supervise the activities of the Safety Management Program by: Periodic review and update of all safety management policies and procedures to include, ... management plan, and fire safety and evacuation plan to comply with JCAHO, Medicare , OSHA, and other regulatory agencies; Coordinate and implement fire and emergency… more
- HCA Healthcare (Sarasota, FL)
- …the preparation of the annual financial reports including but not limited to: Medicare Cost Report, work paper package and the AHCA prior year report package. ... procedures. + You will assist in the preparation, coordination, review , and compilation of the capital and operating budgets...trend performance. We have been named by Becker's Hospital Review among the top 100 hospitals with great orthopedic… more
- Gentiva (Winter Garden, FL)
- …Group (IDG), as assigned, including presiding over IDG, presentation of patients for review , coordination of minutes, review of patient charts to note and ... practice, including industry standards, regulations, and best practices (ie, Medicare , Medicaid, JCAHO, ACHC), company policies/procedures, and understanding ofterminally… more
- HCA Healthcare (Miami, FL)
- …leadership + Work with team members in billing, revenue integrity and/or the Medicare Service Center to resolve alerts/edits + Assign interim DRGs for in-house ... lead, manager, international log) + Periodically works with manager to review individual work accomplishments, discuss work problems/barriers, discuss progress in… more
- Cognizant (Tallahassee, FL)
- …team and collaborate with stakeholders and other teams. **Primary Responsibilities** : + Review claim system data and verify against UB or HCFA paper or EDI ... UB/institutional (CMS-1450) and/or professional (CMS 1500) claims. + Knowledge of Medicare /Medicaid payment and coverage guidelines and regulations. + Must be able… more
- HCA Healthcare (Miami, FL)
- …and continued stay and discharge criteria. Orientation will also include Medicare and insurance benefits, grievance procedures, treatment plan process, and rights ... experience required + Certification in case management or utilization review preferred + InterQual experience preferred HCA Florida Mercy...to apply for our Case Mgr RN opening. We review all applications. Qualified candidates will be contacted by… more
- HCA Healthcare (Fort Pierce, FL)
- …and continued stay and discharge criteria. Orientation will also include Medicare and insurance benefits, grievance procedures, treatment plan process, and rights ... nursing experience required + Certification in case management or utilization review preferred InterQual experience preferred HCA Florida Lawnwood Hospital is a… more
- HCA Healthcare (Aventura, FL)
- …and continued stay and discharge criteria. Orientation will also include Medicare and insurance benefits, grievance procedures, treatment plan process, and rights ... nursing experience required + Certification in case management or utilization review preferred + InterQual experience preferred HCA Florida Aventura Hospital is… more
- CenterWell (Daytona Beach, FL)
- …experience, quality of care, clinical outcomes, and avoidable utilization *Periodically review clinician charts to identify opportunities in care, ensuring clinical ... indicators (KPIs), such patient experience via Net Promoter Score (NPS) and Medicare clinical quality via HEDIS, meeting local and organizational goals *Personally… more