- Molina Healthcare (FL)
- …and experience. + At least 3 years of Experience with Medicaid and/or Medicare . + Proven experience owning operational projects from concept to execution, especially ... ability to synthesize complex information. **PREFERRED QUALIFICATIONS:** + Experience with Medicare , Medicaid, and Marketplace lines of business. + PMP, Certified… more
- Evolent (Tallahassee, FL)
- …Join our Utilization Management team as a Field Medical Director, Cardiovascular Specialist and use your expertise in interventional cardiology to help ensure the ... by any state or federal health care program, including Medicare or Medicaid, and is not identified as an...General Service Administration (GSA), or reprimanded or sanctioned by Medicare . + No history of a major disciplinary or… more
- ChenMed (Miami, FL)
- …is used accurately and effectively. Collaborates with referral management to ensure specialist network is adequate for the geography and escalates accordingly when ... experience/understanding + Understanding of cost as it relates to Medicare parts A, B and D + Proficient in...decision based of the data + Experience working in Medicare managed care environment We're ChenMed and we're transforming… more
- CenterWell (Jacksonville, FL)
- …indicators (KPIs), such patient experience via Net Promoter Score (NPS) and Medicare clinical quality via HEDIS, meeting local and organizational goals + Personally ... primary care including health promotion & prevention, disease management, effective specialist & hospital co-management, and complex care management + Spend 20-30%… more
- Polaris Pharmacy Services, LLC (Fort Lauderdale, FL)
- …Remote Position Type Full Time Job Category Pharmaceutical Description PRIOR AUTHORIZATION SPECIALIST (REMOTE) WHO WE ARE Polaris Pharmacy Services is an industry ... Authorization Technicians to join the Polaris team. OVERVIEW The Prior Authorization Specialist is responsible for managing and identifying a portfolio of rejected… more
- AdventHealth (Altamonte Springs, FL)
- …nursing, and care management. This includes quarterly compliance updates from Medicare . + Effectively and appropriately communicates with physicians and other ... Department experience. . Two (2) years of Clinical Documentation Specialist experience **LICENSURE, CERTIFICATION OR REGISTRATION REQUIRED:** . Current active… more
- Banner Health (FL)
- …and regulations according to regulatory agencies for state Medicaid plans, Center for Medicare Services (CMS), Office of the Inspector General (OIG) and the Health ... least one of the following: Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Coding Specialist - Physician (CCS-P), Registered… more
- AdventHealth (Palm Coast, FL)
- …car insurance **Preferred qualifications:** . Recent, relevant experience in a Medicare -certified home health agency as a case-manager . Certified Case Manager ... . Certificate for OASIS Specialist - Clinical This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws,… more
- AdventHealth (Maitland, FL)
- …role you'll contribute:** The Pre-Access Infusion Benefits and Authorization Specialist , under general supervision, maintains performance standards appropriate to ... requirements. + Verifies medical necessity in accordance with Centers for Medicare & Medicaid Services (CMS) standards by reviewing guidelines and communicates… more
- ChenMed (Hallandale Beach, FL)
- …the assigned centers. + Participates in recruiting and interviewing PCP and specialist candidates. + Partners with Clinical COE and Talent Acquisition to support ... one (1) years' previous experience as Medical Director or equivalent with a Medicare or Medicaid patient population + Board eligibility is required. + Board… more