- Elevance Health (Miami, FL)
- ** Director of Medicare Risk Adjustment Analytics and Reporting** **Location:** Alternate locations may be considered. This position will work a hybrid model ... will live within 50 miles of our Elevance Health PulsePoint locations. The ** Director of Medicare Risk Adjustment Analytics and Reporting** is responsible for… more
- Molina Healthcare (Miami, FL)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
- CVS Health (Plantation, FL)
- …has an exciting opportunity to join its leadership team as an Executive Director , Network Management supporting our Florida market for our Commercial, Medicare , ... Health resources to enable and improve clinical outcomes. + Responsibility for understanding medical cost issues and medical cost ratios (MLRs) and initiating… more
- Wellpath (Fort Lauderdale, FL)
- …* Growth and training **Perks and Benefits** In addition to comprehensive benefits including medical , dental, vision, paid time off, and 401k, we foster a work, life ... and point of care support. **How you make a difference** The Assistant Director of Nursing (ADON)is responsible formanaging and supervising the nursing staff and… more
- Elevance Health (Miami, FL)
- **Clinical Quality Program Director ** **Preferred Location: Florida. This position is hybrid and will require the associate to report to the office at least 1-2 ... **11430 NW 20th Street, Miami, FL 33172** The **Clinical Quality Program Director ** is responsible for developing a national quality improvement strategy for a… more
- Elevance Health (Miami, FL)
- …care. CarelonRx's Pharmaceutical Rebates Org is looking to hire a ** Director , Formulary Strategy Development.** This high-performing individual contributor will play ... in driving affordability across multiple lines of business (Commercial, Medicaid, Medicare , ASO clients) by partnering with internal and external stakeholders to… more
- Molina Healthcare (Miami, FL)
- …Access, Word and Excel * Knowledge and understanding of claims processing systems and medical claims * Knowledge of HMO, PPO, POS, MCO, Medicare , Medicaid, ... Market Place products, laws, rules and regulations **Preferred Education** * Master's degree **Preferred Experience** * Formalized training/experience in Health Care Insurance Fraud * Experience with Power BI, SAS, SQL other reporting software * ICD-10 CPT-4,… more
- University of Miami (Miami, FL)
- …when necessary + Performs other duties as assigned by the Chief and/or clinic Medical Director + Experience with Medicare Advantage (65+) patient population ... evaluations. This role also works directly with staff, administration, medical directors, and other relevant stakeholders to assure appropriate...preferred + Completion of Medicare annual wellness exam documentation preferred + Knowledge of… more
- Elevance Health (Miami, FL)
- …+ May process a medical necessity denial determination made by a Medical Director . + Refers complex or non-routine reviews to more senior nurses ... organization with health plans for people enrolled in Medicaid and/or Medicare programs in Florida. ** Medical Management Clinician Associate** **Location:**… more
- University of Miami (Medley, FL)
- …and maintains high-level accounting financial records and reports and assists the Director of Health System Pricing and Reimbursement in all physician and hospital ... reports on all supplemental Federal and State reimbursement matters. + Administers Medicare and Medicaid audits and prepares all supporting work papers and… more
- HCA Healthcare (Plantation, FL)
- …and retirement of our colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no cost or for a low ... as well as free telemedicine services and free AirMed medical transportation. + Additional options for dental and vision...Rehab patient. The CM collaborates with the Rehab Program Director and Facility Case Management Director regarding… more
- HCA Healthcare (Miami, FL)
- …and retirement of our colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no cost or for a low ... as well as free telemedicine services and free AirMed medical transportation. + Additional options for dental and vision...Rehab patient. The CM collaborates with the Rehab Program Director and Facility Case Management Director regarding… more
- HCA Healthcare (Tamarac, FL)
- …and retirement of our colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no cost or for a low ... as well as free telemedicine services and free AirMed medical transportation. + Additional options for dental and vision...Rehab patient. The CM collaborates with the Rehab Program Director and Facility Case Management Director regarding… more
- HCA Healthcare (Coral Springs, FL)
- …discharge notes and patient communication. + You will consult with Program Director and Rehab Physician/ Medical Director regarding pre-screen assessments ... colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no...quality care during their recovery at home. We are Medicare certified. Our patients are under the supervision of… more
- HCA Healthcare (Margate, FL)
- …and retirement of our colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no cost or for a low ... as well as free telemedicine services and free AirMed medical transportation. + Additional options for dental and vision...Rehab patient. The CM collaborates with the Rehab Program Director and Facility Case Management Director regarding… more
- HCA Healthcare (Miami, FL)
- …and retirement of our colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no cost or for a low ... as well as free telemedicine services and free AirMed medical transportation. + Additional options for dental and vision...Rehab patient. The CM collaborates with the Rehab Program Director and Facility Case Management Director regarding… more
- HCA Healthcare (Miami, FL)
- …and retirement of our colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no cost or for a low ... as well as free telemedicine services and free AirMed medical transportation. + Additional options for dental and vision...Rehab patient. The CM collaborates with the Rehab Program Director and Facility Case Management Director regarding… more