1mo
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Registered Nurse Care Manager -Value Based Care (Must Reside in FL)
Orlando or Florida
RemoteFull Time
3+ YOEActive unrestricted RN license, 3–5 years clinical nursing experience (cardiology or care management preferred), experience with value-based care, strong clinical assessment/triage, leadership, documentation in care management system and EMR; remote work in Florida required.
Care Management system, Electronic Medical Record (EMR)
3mo
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Care Review Clinician (RN) - Remote in FL
Miami or Jacksonville or St Petersburg or Orlando or Tampa
RemoteFull Time
2+ YOERN with at least 2 years in hospital acute care, inpatient review, prior authorization, managed care or equivalent; active RN license in state of practice; strong communication and time-management skills.
1mo
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Care Manager (BH Licensed)- must reside in FL Counties: Seminole, Orange, Osceola, Brevard
Long Beach or Melbourne or Palm Bay or Kissimmee or Cocoa or Sanford or Miami or St. Petersburg or Jacksonville or Tampa or Orlando
$26-$51/hr RemoteFull Time
2+ YOE2+ years health care experience; licensed behavioral health clinician; valid driver’s license; travel 25-40%; field-based care management; pediatric experience preferred.
Microsoft Office
2w
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Manager of Network Contracting - Remote EST preferred
Orlando or United States
$92k-$164k/yr RemoteFull Time
5+ YOE3+ Mgmt5+ years in health care network management, project management, knowledge of RBRVS/DRGs/ASC groupers, experience with government programs; supervisory and VACCN contracting experience preferred.
1mo
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Care Coordinator Lead
Orlando or New York or New Jersey or Maryland or District of Columbia or Virginia or Oklahoma or Kansas or Pennsylvania or Texas or Florida or Georgia
$75k-$85k/yr RemoteFull Time
3+ YOE1+ MgmtActive Florida RN license, 3+ years care coordination or clinical operations experience, 1+ year supervisory experience, EHR/EMR proficiency, Microsoft Teams/Outlook experience, and Medicare/Medicaid billing knowledge.
EHR, EMR, Microsoft Teams, Microsoft Outlook, Cover My Meds, LabFlorida, RapidXUS, Office Ally, OA (EHR)
1mo
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Director, Value-Based Programs (Remote in FL)
Orlando or Tampa or Jacksonville or Miami or St Petersburg or Long Beach or Florida
$97k-$190k/yr RemoteFull Time
8+ YOE3+ Mgmt8+ years managed care experience including VBP, 3+ years management, experience with Medicaid/Medicare/Marketplace, knowledge of risk adjustment, HEDIS and Medicare STARS, coding, medical economics, and Microsoft Office proficiency.
Microsoft Office, Healthcare Effectiveness Data and Information Set (HEDIS), Medicare STARS
2d
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Program Director - Home Health Coordinator Planning Office (Florida Health Plan) - Remote in Florida
Florida or Jacksonville or Miami or Orlando or St Petersburg or Tampa
$80k-$157k/yr RemoteFull Time
7+ YOE3+ MgmtBachelor's degree,7+ years healthcare operations or managed care leadership,3+ years direct leadership,experience with Medicaid/managed care/home health preferred,strong analytical, regulatory and cross-functional coordination skills.
4mo
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Analyst, Business - SQL (Remote in Florida)
Miami or St Petersburg or Tampa or Jacksonville or Orlando
RemoteFull Time
2+ YOE2+ years in managed care/health insurance or related field; SQL knowledge preferred; strong analytical and communication skills.
SQL, Office Suite (Word, Excel, Outlook, Teams), Data Analysis
1mo
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Network Relations Manager – Florida
Florida or Orlando or Clearwater or West Palm Beach or Cape Coral or Miami or Tampa or Hollywood or Fort Myers or Sarasota or Lakeland or Clearwater Beach or Naples or Fort Lauderdale or Fort Myers Beach or Pompano Beach or Saint Petersburg or Kissimmee
$60k-$133k/yr RemoteFull Time
5+ YOEMinimum 5 years provider relations/network management experience, 3+ years in Managed Care, proficiency with Microsoft Office, strong problem-solving and collaboration skills, must reside in Florida; Bachelor's preferred.
Microsoft Excel, Microsoft Word, Microsoft PowerPoint, Microsoft Outlook
1mo
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Contract Negotiation Manager (Florida)
Florida or Orlando or Clearwater or West Palm Beach or Miami or Tampa or Hollywood or Fort Myers or Sarasota or North Fort Myers or Clearwater Beach or Naples or Fort Lauderdale or Fort Myers Beach or Pompano Beach or Saint Petersburg or Kissimmee
$60k-$133k/yr RemoteFull Time
5+ YOE5+ years related experience with managed care negotiations, 3+ years provider relations, Florida residency required, Microsoft Office proficiency, bachelor’s degree preferred.
Microsoft Excel, Microsoft Word, Microsoft PowerPoint, Microsoft Outlook
3mo
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Senior Health Educator - Pediatric Experience (Remote in Florida)
Jacksonville or Miami or Orlando or St Petersburg or Tampa
RemoteFull Time
3+ YOE3-5 years in Health Education with experience in managed care; Bachelor's in Health Education/Promotion or Public Health; MS/BS with certification acceptable; excellent communication and MS Office skills.
Microsoft Office
2w
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Executive Area Manager - Orlando
Orlando or Rolla
RemoteFull Time
5+ YOEBS/BA or equivalent, 5+ years medical sales experience (wound care preferred), O.R./Surgical/VAC submission experience required, skin substitute experience preferred, startup/medium company experience preferred.
1mo
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Advanced Practice Provider (TMP Program)
Lake Wales, Florida, United States
$120k-$130k/yr HybridFull Time
Licensed nurse practitioner required; experience with chronic care management, remote patient monitoring, or behavioral health integration preferred; strong communication and ability to travel to multiple facilities.
1mo
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Advanced Practice Provider (TMP Program)
Clermont, Florida, United States
$125k-$130k/yr HybridFull Time
Licensed nurse practitioner required; experience with chronic care management, remote patient monitoring, or behavioral health integration preferred; must travel to assigned facilities and analyze clinical reports; strong communication skills.
1w
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Clinical Review Nurse Lead
Indianapolis or Atlanta or Lake Mary or Tampa or Miami or Cincinnati or St. Louis or Grand Prairie
RemoteFull Time
7+ YOECurrent unrestricted RN license, AS in nursing (or equivalent), 7+ years acute care experience, managed care experience preferred, ability to assess medical necessity and interpret policy.
1w
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Appeals and Grievances Clinical Specialist
New York City or Lake Mary or New York or North Dakota or Indiana or Virginia or Texas or Tennessee or South Carolina or Pennsylvania or Ohio or Nevada or New Jersey or North Carolina or Minnesota or Maryland or Massachusetts or Kansas or Illinois or Iowa or Georgia or Florida or Delaware or Connecticut or Colorado or New Hampshire or Vermont or Arizona or Alabama or Maine or Utah or Mississippi or Montana or South Dakota or Nebraska or New Mexico or Washington or Michigan or Oklahoma
$73k-$120k/yr RemoteFull Time
Active registered nurse (rn) required; experience in appeals & grievances, utilization review, claims processing preferred; familiarity with Utilization Review guidelines and care management systems; strong documentation and case management skills.
Microsoft Word, Microsoft Excel, Macess, CCMS, TruCare, Hyland, InterQual, Milliman
1w
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Appeals and Grievances Clinical Specialist
New York City or Lake Mary or New York or New Jersey or Connecticut
$73k-$120k/yr RemoteFull Time
Active RN required; BLS/CPR required, ACLS preferred; experience in clinical practice and appeals & grievances or utilization review; knowledge of Utilization Review guidelines; proficiency with Word/Excel and care management systems.
Microsoft Word, Microsoft Excel, Macess, CCMS, TruCare, Hyland, InterQual, Milliman
1mo
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Health Benefits Claims Examiner Representative
Orlando, Florida, United States
$21-$22/hr RemoteFull Time
0.5+ YOEAt least 6 months healthcare/insurance operations experience; experience with billing, coding, or provider maintenance preferred. Strong verbal/written communication, time-management, Windows/keyboard and Microsoft Excel skills; Blue Care and medical coding a plus.
Microsoft Excel, Microsoft Windows, Microsoft Teams, Blue Care
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