- 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
- CVS Health (Tallahassee, FL)
- … review , diagnosis coding, and/or auditing. + Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and Hierarchical Condition ... teams prior to the submission to the Centers of Medicare and Medicaid Services (CMS) for the purpose of...Classification of Disease (ICD) codes required. + Experience with Medicare and/or Commercial and/or Medicaid Risk Adjustment process and… more
- CenterWell (Port Saint Lucie, FL)
- …defined by Clinical Leadership. Meets with RMD about quality of care, review of outcome data, policy, procedure and records issues. Participates in potential ... screened for TB. **Preferred Qualifications:** Active and unrestricted DEA license Medicare Provider Number/ Medicaid Provider Number Experience managing Medicare… more
- Elevance Health (Tampa, FL)
- …member of Elevance Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare and Medicaid Services ... issues as assigned. + Participates in special projects and review of work done by lower level auditors as...a minimum of 5 years of audit/reimbursement or related Medicare experience; or any combination of education and experience,… more
- ChenMed (Margate, FL)
- …related to appointment, uploading into organization's medical record system for physician review prior to PCP follow-up appointment. + Ensures any missed external ... understanding of the company's patient population, including the complexities of Medicare programs + Exceptional organizational skills with the ability to… more