- Prime Therapeutics (Tallahassee, FL)
- …qualified entities across all lines of business to support the Centers for Medicare & Medicaid Services (CMS) Star and HEDIS quality measure programs, including but ... meets the specialized needs of the targeted population; for Medicare , is Centers for Medicare & Medicaid...$17.85 - $25.48 based on experience and skills. To review our Benefits, Incentives and Additional Compensation, visit our… more
- CenterWell (Deerfield Beach, FL)
- …defined by Clinical Leadership. . Meets with RMD about quality of care, review of outcome data, policy, procedure and records issues. . Participates in potential ... Medicine or Geriatric Medicine preferred . Active and unrestricted DEA license . Medicare Provider Number . Medicaid Provider Number . Minimum of two to five… more
- AdventHealth (Maitland, FL)
- …quantify, and present contract compliance violations. He/she will perform extensive review of contract language, state and federal regulations, and payor practices ... This person demonstrates attention to detail and competencies in contract language review , research, decision support, and financial analysis in the preparation and… more
- Elevance Health (Tampa, FL)
- …end-to-end claims/ encounter processing, as well as ensuring compliance with Medicare / Medicaid regulatory policies regarding FFS and zero-dollar claims. **How you ... associated reporting and KPIs. + Oversees design and execution of provider/chart review workflows to ensure high quality encounter submissions. + Liaises with senior… more
- Prime Therapeutics (Tallahassee, FL)
- …strategy. This role provides leadership and subject matter expertise on Medicare Stars, Medicaid quality and the Commercial/Health Insurance Marketplace Quality ... goals + Drive the client quality strategy for all lines of business ( Medicare , Medicaid, Commercial/HIM); serve as primary point of contact and subject matter expert… more
- Prime Therapeutics (Tallahassee, FL)
- …lines of business (Employer Markets, Health Insurance Marketplace (HIM), Commercial, Medicare , and Medicaid). This individual is the primary relationship and ... Lead retention efforts for Employer Markets, Health Insurance Marketplace, Commercial, Medicare , and Medicaid health plan clients; drive the adoption and consistent… more
- Molina Healthcare (FL)
- …medical director, and quality improvement staff. + Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews quality referred ... requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the denial process. + Monitors appropriate care and services… more
- Intermountain Health (Tallahassee, FL)
- …Integrity (CDI) Registered Nurses (RN) and Intermountain Physician Advisors to review complex facility encounters and assign International Classification of Diseases ... optimization of reviews while patients are hospitalized. It aids in the review of quality measures including Patient Safety Indicators and Hospital Acquired… more
- Highmark Health (Tallahassee, FL)
- …drug benefit strategies, drug formularies, and programs specifically for the Medicare Advantage (MA) market. The incumbent will contribute to recommendations for ... and stakeholders across the organization. Key responsibilities will include clinical review , assisting in navigating a complex regulatory environment, working with… more
- CenterWell (Delray Beach, FL)
- …defined by Clinical Leadership. + Meets with AMD about quality of care, review of outcome data, policy, procedure and records issues. + Participates in potential ... Medicine or Geriatric Medicine preferred . Active and unrestricted DEA license . Medicare Provider Number . Minimum of two to five years directly applicable… more