- HCA Healthcare (Brooksville, 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. ... Company policies and procedures. + You will assist in the preparation, coordination, review , and compilation of the capital and operating budgets for all entities. +… more
- Elevance Health (Tampa, FL)
- …to refer or assign case (utilization management, case management, QI, Med Review ). + Provides information regarding network providers or general program information ... all actions. + Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical information. **Minimum… 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 (Panama City, FL)
- …are high. **What you will do in this role:** + Coordinate NCD/LCD/LCA review process at the Division level + Determine whether new/revised NCDs/LCDs/LCAs apply to ... resolution + Monitor compliance with HCA Healthcare Policy REGS.GEN.011, Medicare - National and Local Coverage Determinations + Government/Non-government medical… 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
- Centene Corporation (Tallahassee, FL)
- …State Contract Quality, Pay-for-Performance/Withhold programs, Marketplace QRS, and Medicare Quality metrics. Also accountable for identifying and implementing ... programing, ensuring alignment with strategic goals and regulatory requirements + Review and present results of quality interventions for clinical and operational… more
- Cardinal Health (Doral, FL)
- …insurance associate on the revenue cycle management team. **Responsibilities:** + Review aging reports and work insurance accounts to ensure timely resolution ... claim processing and denial management preferred. + Familiarity with Medicare , Medicaid, and managed care preferred. + Proficiency in...other status protected by federal, state or local law._ _To read and review this privacy notice click_ here… more
- Genesis Healthcare (Oxford, FL)
- …Clinical Operations Area Director in the timely completion of the annual merit review for therapy staff. 6. Assists Clinical Operations Area Director in the hiring ... and coordinates the timely completion of the annual merit review for therapy staff. 8. Assumes responsibility for hiring...period of one year. 5. A thorough knowledge of Medicare and third party billing is also required. Posted… 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