- 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
- MyFlorida (Naples, FL)
- …clients and representatives from 3rd party insurance companies, Medicaid, and Medicare for the verification of insurance and coverage. Additionally, this position ... This position reports to the TB PROGRAM MANAGER-NURSING PROGRAM SPECIALIST . Your Specific Responsibilities: Medical Billing: Performs billing functions for… more
- Molina Healthcare (Orlando, FL)
- …Procedure Coding (HCPC). * Experience demonstrating knowledge of Centers for Medicare and Medicaid Services (CMS) guidelines, MCG, InterQual or other medically ... appropriate clinical guidelines, Medicaid, Medicare , CHIP and Marketplace, applicable state regulatory requirements, including ability to easily access and interpret… more
- Molina Healthcare (Tampa, FL)
- …compliance with the National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), state Medicaid entity requirements and all ... delegated groups. + Assists in preparation of documents for Centers for Medicare and Medicaid Services (CMS), state Medicaid, National Committee for Quality… more
- CVS Health (Tallahassee, FL)
- …within budgeted costs. **What you will do** + Acts as a top-level specialist on project management and develops a comprehensive plan that encompasses objectives, ... Qualifications** + Pharmacist + 7-10 years work experience in healthcare + Medicare and/or Medicare -Medicaid Integrated Product Experience + Experience with Part… more
- MyFlorida (Orlando, FL)
- …OPEN COMPETITIVE APPOINTMENT Class Title: Senior Human Services Program Specialist Position Number: 64003893 Salary: $1,680.00 Biweekly Program: Sunshine Care ... and deductibles of various types of insurance to include Medicare , Medicaid, private insurance, ACA Health Insurance, or VA...to life and making changes + Educate clients on Medicare Parts C and D and their co-payments and… 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 **PAY RANGE:** $48,418 - $69,168… more
- ChenMed (Clearwater, FL)
- …opportunities within the CPL. + Responsible for meeting with high volume community specialist at least monthly to give them feedback on their referring trends and ... related field is required + Healthcare experience within the Medicare HMO population is a plus + A valid,...within the market + Prior experience working in a Medicare Managed Care environment preferred **PAY RANGE:** $57,525 -… 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), Certified… more