• Medical Director (Marketplace)

    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
    Molina Healthcare (02/06/25)
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  • Special Investigation Unit Coding Director

    CVS Health (Plantation, FL)
    …workflows to enhance accuracy and productivity. * Collaborate closely with the SIU Medical Director to align coding practices with organizational goals. * Work ... care more personal, convenient and affordable. **Position Summary:** As the Coding Director , you will oversee the coding operations, ensuring accurate and efficient… more
    CVS Health (02/21/25)
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  • Director of Accounting and Compliance

    Monte Nido (Miami, FL)
    …while providing the opportunity for people to realize their healthy selves. ** Director of Accounting and Compliance** **Monte Nido** **Remote** **Monte Nido** is a ... care that supports long-term recovery. We are seeking a Director of Accounting and Compliance to join our finance...your success and well-being, providing: + Competitive compensation + Medical , dental, and vision insurance coverage (Benefits At a… more
    Monte Nido (03/09/25)
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  • Director , Special Investigations Unit,…

    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-9, ICD-10… more
    Molina Healthcare (03/15/25)
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  • APP, Supervisor - General Internal Medicine - Full…

    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
    University of Miami (12/17/24)
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  • Primary Care Physician

    CenterWell (Fort Lauderdale, FL)
    medical expertise with the care team through daily huddles. . Helps Regional Medical Director and Center Administrator in setting a tone of cooperation in ... Doctors, Advanced Practice professionals, Pharm D, Care Coach Nurses, Medical Assistants, Behavioral Health, Specialists, Quality Based Coders, Referral Coordinators… more
    CenterWell (02/22/25)
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  • Reimbursement Analyst 3

    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
    University of Miami (03/14/25)
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  • Case Mgr RN PRN

    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 (03/04/25)
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  • Case Mgr RN

    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 (02/15/25)
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  • Cse Mgr RN

    HCA Healthcare (Aventura, 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 (03/14/25)
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  • PRN ST Home Health

    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 (03/12/25)
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  • RN Case Manager

    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 (02/20/25)
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  • RN Case Manager

    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 (03/13/25)
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  • Case Mgr RN

    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 (03/08/25)
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  • RN Case Manager

    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 (01/09/25)
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  • Home Health/ Registered Physical Therapist

    Humana (Boca Raton, FL)
    …orders and plan of care under the direction and supervision of the Director of Clinical Services/Clinical Manager. Such care must be provided in accordance with ... on Allied Health Education and Accreditation of the American Medical Association, or the Council of Medical ...to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities… more
    Humana (12/27/24)
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  • Pharmacist, Per Diem

    Humana (Miramar, FL)
    …designs and monitors care plans that are unique and tailored specifically to the medical condition of the patient. + Gathers all pertinent medical information ... programs, and professional organizations as requested or directed by the Pharmacy Director . + Completes continuing education programs as required for position duties… more
    Humana (03/04/25)
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  • Patient Access Liaison

    Grifols Shared Services North America, Inc (Hollywood, FL)
    …including HCPs and their staff, Market Access, the US Pulmonary National Sales Director and Regional Sales Directors and SP/Hub partners in the field, supporting ... and affordability solutions across multiple payer types and plans (ie, Medicare , Medicaid Managed Care, Commercial) Champion and manage the appropriate utilization… more
    Grifols Shared Services North America, Inc (02/25/25)
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  • Reg Mgr, Value-Based Prgms

    Molina Healthcare (Miami, FL)
    …with national quality and risk adjustment VPs, Regional Directors of Quality/Risk, Director of Value Based Programs, medical economics/actuaries and local health ... program & contract design and implementation for marketplace, Medicaid and/or Medicare + Experience in a complex healthcare delivery environment, specifically with… more
    Molina Healthcare (03/13/25)
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  • Senior Manager, Referrals-1

    ChenMed (Miami, FL)
    …+ Implements strategic planning for referral coordination that contributes to medical cost reduction and improves organizational performance. + Interviews Referral ... to improve referral outcomes. + Participates in executive team and Network Director meetings to collaborate for referral improvements and solutions. + Travels to… more
    ChenMed (03/07/25)
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