• RN Case Mgr

    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
    HCA Healthcare (07/14/25)
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  • Associate Medical Director

    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
    CenterWell (06/12/25)
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  • Manager of Clinical Operations

    Prime Therapeutics (Tallahassee, FL)
    …Qualifications** + Previous experience with RxClaim + Previous experience with Medicare or Medicaid Every employee must understand, comply with and attest ... ranges from $81,000.00 - $138,000.00 based on experience and skills. To review our Benefits, Incentives and Additional Compensation, visit our Benefits Page… more
    Prime Therapeutics (08/31/25)
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  • Associate Specialist, Appeals & Grievances

    Molina Healthcare (FL)
    …with the standards and requirements established by the Centers for Medicare and Medicaid. **KNOWLEDGE/SKILLS/ABILITIES** + Enters denials and requests for appeal ... into information system and prepares documentation for further review . + Research issues utilizing systems and other available resources. + Assures timeliness and… more
    Molina Healthcare (08/30/25)
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  • Sr. VP of FMO

    Insight Global (Miami, FL)
    …keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/. Skills ... field sales teams, agents and channel performance * Deep understanding of ACA, Medicare Advantage, and Life insurance distribution * Bilingual in English and Spanish… more
    Insight Global (08/30/25)
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  • Transition of Care Associate - Licensed Practical…

    CVS Health (Tallahassee, FL)
    …advocates for members who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current case management and ... (CKD), post-acute care, hospice, palliative care, cardiac, home health with Medicare members **Preferred Qualifications** + 4+ years of Licensed Practical Nurse… more
    CVS Health (08/30/25)
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  • Director, Government Pricing/Managed Care Rebate…

    Bristol Myers Squibb (Tampa, FL)
    …of a team responsible for accurate and timely Managed Care Commercial and Medicare Part D rebate processing and payments, data stewardship and compliance in ... deal structures to inform business, financial and government pricing calculation + Review and approve the monthly and quarterly Managed Care processes that support… more
    Bristol Myers Squibb (08/30/25)
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  • Dermatology NP/PA Clinical Specialist- North…

    Bristol Myers Squibb (Tallahassee, FL)
    …strategies to drive performance and execution within the role + Develop, review , and modify Territory-level business plans ensuring alignment with national plans + ... governing rules and laws. + Possess a strong understanding of Commercial payers, Medicare plans and state Medicaid in geography. + Immunology experience (emphasis on… more
    Bristol Myers Squibb (08/30/25)
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  • Home Health Physical Therapist Part Time

    Aveanna Healthcare (Punta Gorda, FL)
    …Documents effectively resulting in no technical or clinical denials subsequent to review of documentation by payers + Maintain effective communication between staff, ... Health Therapy and completion of OASIS documentation As an employer accepting Medicare and Medicaid funds, employees must comply with all health-related requirements… more
    Aveanna Healthcare (08/30/25)
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  • Patient Care Technician - PCT

    Fresenius Medical Center (Jacksonville, FL)
    …the designated clinical application in an accurate and timely manner. + Review treatment sheets for completeness, ensure nursing signatures are documented, and ... **LICENSES:** + HighSchooldiplomaorG.E.D. required. + Must meet Center for Medicaid/ Medicare Services (CMS)-approved state and/or national certification requirements within… more
    Fresenius Medical Center (08/30/25)
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