Care Management Support Assistant Humana IncCare Management Support AssistantClermont, FL$38,000–$45,800 / yearAs the largest provider of senior-focused primary care, a leading provider of home healthcare and a leading integrated home delivery, specialty, hospice and retail pharmacy, CenterWell is focused on whole health and addressing the physical, emotional and social wellness of our patients. About CenterWell Senior Primary Care: CenterWell Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more.
Program Administrator, Vendor Management Elevance HealthProgram Administrator, Vendor ManagementMiami, FLAdministers the implementation and compliance of on-going external client facing programs; ensures program meets its stated objectives; provides subject matter expertise in response to day to day business issues; researches applicable subject matter practices and remains aware of industry trends. Manages relationships and partners with corporate and regional business areas; coordinates training related to the client facing program; develops program success measures and performs periodic assessments of external client facing program success.
NewWound Care Utilization Management RN Elevance HealthWound Care Utilization Management RNMiami, FL$39.34–$56.20 / hourThe Wound Care Utilization Management RN will be responsible for performing pre-certification and/or authorization activities for Home Health Services for members with wound care needs included as contracted services that meet eligibility and benefits coverage. For the Wound Care Connect program, in addition to Wound Care Certification requirements above, Ostomy training through accredited programs such as WOCN or ABWM and Ostomy experience is also required.
Senior Director, Product Management Pharmacy Solutions SS&C Technologies Holdings IncSenior Director, Product Management Pharmacy SolutionsJacksonville, FLRemoteThis role serves as the business owner for one or more strategic product domains within the pharmacy platform, partnering across Product, Technology, Operations, Clinical, Sales, Marketing, and Client Success teams to deliver innovative solutions that drive client value and business growth. Unless explicitly requested or approached by SS&C Technologies, Inc. or any of its affiliated companies, the company will not accept unsolicited resumes from headhunters, recruitment agencies, or fee-based recruitment services.
Emergency Management Specialist - Day - Full Time - Volusia Brevard and Indian River County - Orlando Health facilities Orlando Health Ventures l LLCEmergency Management Specialist - Day - Full Time - Volusia Brevard and Indian River County - Orlando Health facilitiesFLWhat you will do Assists with ensuring compliance on regulatory, statutory, and other emergency management and homeland security requirements including Centers for Medicare & Medicaid Services (CMS), The Joint Commission (TJC), Agency for Healthcare Administration (AHCA), Department of Health (DOH) Trauma Program, American College of Surgeons (ACS), American Burn Association (ABA), Radiation Injury Treatment Network (RITN), Central Florida Disaster Medical Coalition (CFDMC), National Weather Service, Occupational Safety and Health (OSHA), National Incident Management System (NIMS) and Department of Homeland Security. Interacts with all departments and agencies including Clinical, Support Services, Ancillary, Human Resources, Infection Prevention and Control, Occupational Health, Quality Management, Security, Safety, PBX Contact Centers, Media Relations, Internal Communications, Information Technology, Administration, Senior Leadership, Engineering, Risk Management, Emergency Responders, Department of Health, and Emergency Management officials.
Director Hospital Revenue Management Orlando Health Ventures l LLCDirector Hospital Revenue ManagementOrlando, FLPosition Summary The Director, Hospital Revenue Management, is responsible for the leadership organization, and planning of all activities related to the following functions for the entire health system: hospital billing, insurance collections, cash posting, denial management, variance resolution and the retention of revenue related to insurance overpayments. Responsibilities Oversight of revenue management functions within the purview of over ten hospital facilities, free standing emergency departments, and other outpatient services Oversight of revenue management functions for new acquisitions and transitional service agreements implemented.
Manager of Quality/Risk Management Parrish Medical CenterManager of Quality/Risk ManagementTitusville, FLFull timeIn collaboration with the multidisciplinary team, the Quality Manager assess, plans, develops, coordinates, implements, and evaluates the daily departmental plan of care to include efficient utilization of schedules, staff, and equipment. Participates in committees as assigned, supports quality assurance activities including initiating, reviewing, and revising policies and procedures, and participates in ongoing process improvement initiatives related to the organization.
NewUtilization Management Representative I Elevance HealthUtilization Management Representative ILake Mary, FLAdditional expectations to include but not limited to: Proficient in maintaining focus during extended periods of sitting and handling multiple tasks in a fast-paced, high-pressure environment; strong verbal and written communication skills, both with virtual and in-person interactions; attentive to details, critical thinker, and a problem-solver; demonstrates empathy and persistence to resolve caller issues completely; comfort and proficiency with digital tools and platforms to enhance productivity and minimize manual efforts. For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
NewProduct Management Director Sr- Supplemental Health Elevance HealthProduct Management Director Sr- Supplemental HealthTampa, FL$128,800–$215,520 / yearMay lead efforts or manage project teams in the implementation of complex regional and companywide initiatives, including portfolio repositioning in a market, legislative changes, network/provider changes, medical management programs, and policy initiatives. Claim exceptions/appeals/fraud, waste, and abuse - coordination with vendor, Compliance and Legal (SIU, if needed) on requested exceptions and, more specifically, on specific claim appeals and overall process.
Centralized Medical Services - Specialist, Care Management ArchWell HealthCentralized Medical Services - Specialist, Care ManagementNew Port Richey, FLEducation and Experience: High school diploma or equivalent requiredMedical Assistant (MA), Licensed Practical Nurse (LPN), or Certified Nursing Assistant (CNA) certification preferredA minimum of 5 years experience as an MA, LPN or CNA, preferably in care management or acute care facility, community-based clinic, public health department or specialization with the senior population or value based care preferredProficient PC skillsExcellent Customer Service and patient centric problem solving requiredFluency in Spanish or other languages spoken by people in the communities we serve is desirable, but not required. Works collaboratively with Nurse Care Managers, Chronic Disease Managers, healthcare providers, and center teams to provide patient support and address non-clinical needs.
NewSpecialist, Care Management ArchWell HealthSpecialist, Care ManagementTampa, FLEducation and Experience: High school diploma or equivalent requiredMedical Assistant (MA), Licensed Practical Nurse (LPN), or Certified Nursing Assistant (CNA) certification preferredA minimum of 5 years experience as an MA, LPN or CNA, preferably in care management or acute care facility, community-based clinic, public health department or specialization with the senior population or value based care preferredProficient PC skillsExcellent Customer Service and patient centric problem solving requiredFluency in Spanish or other languages spoken by people in the communities we serve is desirable, but not required. Works collaboratively with Nurse Care Managers, Chronic Disease Managers, healthcare providers, and center teams to provide patient support and address non-clinical needs.
68064380 - SENIOR MANAGEMENT ANALYST II - SES Government of Florida68064380 - SENIOR MANAGEMENT ANALYST II - SESTALLAHASSEE, FLIn consultation with the Senior Management Analyst Supervisor and/or Audit Director, plans and conducts audits and reviews of programs, systems, controls, records, policies, procedures, performance measures, or activities within the agency or other governmental or third-party entities providing services to the agency. Conducts special investigations of alleged violations of Statutes or Rules, mismanagement, or significant deviation of accepted management or financial practices and, when requested by the Inspector General, assists in investigating complaints related to personnel issues.
Case Management Coordinator ICONMA, LLCCase Management CoordinatorMiami-Dade County, FL$34.13 / hourCase Management Coordinators will determine appropriate services and supports due to member’s health needs; including but not limited to: Prior Authorizations, Coordination with PCP and skilled providers, Condition management information, Medication review, Community resources and supports. Utilizes critical thinking and judgment to collaborate and inform the case management process, in order to facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members through the use of care management tools and resources.
IT Project Coordinator | IT Project Management Office University of Florida Health Science CenterIT Project Coordinator | IT Project Management OfficeGainesville, FLSupport enterprise IT delivery by managing project intake, coordinating governance workflows, and maintaining the structure that enables consistent, transparent decision-making across the organization. Monitors project progress, communicates updates to stakeholders, and facilitates collaboration across cross-functional teams to address challenges and mitigate risks.
Director of Revenue Cycle Management Acadia Healthcare Co IncDirector of Revenue Cycle Managementnavarre beach, FLLead and provide operational directives for all Business office activities related to the claim's management and collections of the facility receivables and ensure timely, efficient cash collections to support the overall financial goals of the facility. Purpose Statement: Twelve Oaks is seeking an experienced Director of Business Office to lead and oversee all business office operations, including financial counseling, billing, collections, and revenue cycle functions.
Medical Assistant - Pain Management Health First IncMedical Assistant - Pain ManagementViera, FLThe Medical Assistant Certified provides and ensures patients receive whole care in all aspects of an office visit, regarding intake, test results, screenings, labs, medication administration, closure of care gaps while delivering excellent customer service to the patients, families and other care Providers, focusing on patient-centered care. Provides coverage in other areas of Health First Medical Group (HFMG) or office to support other departmental needs including patient registration, payment collections, patient checkout and appointment scheduling.
Clin Coord, Bed & Capacity Management| System Admin Office | Day |Full Time University of Florida Health Science CenterClin Coord, Bed & Capacity Management| System Admin Office | Day |Full TimeGainesville, FLWorks collaboratively with nursing leadership, charge nurses, physicians, transfer center staff, patient placement teams, and hospital operations leaders to ensure patients receive the right care, at the right place, at the right time. Supports operational decision-making through data analysis, workflow development, stakeholder engagement, and performance improvement initiatives designed to improve access, capacity, and patient flow.
Director Case Management HiredFirstDirector Case ManagementBradenton, FL$109,000–$164,000Reporting to senior clinical and financial leadership, this director sets the strategic and operational direction for the case management department, including staffing models, skill mix, FTE allocation, and staff competencies. This leadership role oversees all operational aspects of hospital case management, bringing executive-level direction to care coordination, discharge planning, and clinical resource utilization across the department.
Case Management Coordinator Iconma LLCCase Management CoordinatorMiami, FLCase Management Coordinators will determine appropriate services and supports due to member's health needs; including but not limited to: Prior Authorizations, Coordination with PCP and skilled providers, Condition management information, Medication review, Community resources and supports. Utilizes critical thinking and judgment to collaborate and inform the case management process, in order to facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members through the use of care management tools and resources.
Referral Management Clerk (CLR/RMC/Appointment Line Technician) – Eglin AFB, FL Reef SystemsReferral Management Clerk (CLR/RMC/Appointment Line Technician) – Eglin AFB, FLFloridaIn addition to scheduling requested appointments, this position will call patients or respond to secure messaging submissions to schedule, reschedule, and/or cancel appointments as needed, to include appointments for consult/referral specialty care within the MTF or at civilian facilities. Basic Life Support (BLS) as accepted by American Heart Association (AHA) (Heart Savers, Admins) (Providers course) or American Red Cross.