Top 776 Senior case Jobs in Miami Lakes, Fl

Quality Accreditation Coordinator
Solis Health Plans —Doral, FL
- $25 - $30 an hour
- Weekends as needed
- Spanish
- Ability to walk for extended periods
- English
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Senior Investigator, Special Investigations Unit (Aetna SIU) - Must reside in Florida
CVS Health —Plantation, FL
- $46,988 - $102,000 a year
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Customer service
- Health insurance
- Dental insurance
Senior Paralegal
Keller Postman —Coral Gables, FL
- $55 - $90 an hour
- Full-time
- Hybrid work
- Microsoft Excel
- Microsoft Outlook
- Writing skills
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Sr RN - Optum Infusion
Optum —Miramar, FL
- $35.00 - $62.50 an hour
- Overtime
- Nursing
- OSHA
- RN License
- Flexible schedule
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12d
Senior Civil Rights Specialist
Florida International University —Miami, FL
- $60,000 - $70,000 a year
- Online Application
- Master's degree
- University
- Bachelor's degree
Senior Analyst - Payments
Hard Rock Digital —Hollywood, FL
- Full-time
- Hybrid work
- Computer literacy
- Mid-level
- Microsoft Office
- Flexible schedule
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Finance - Administrative Assistant
Blackstone Group —Miami, FL
- $70,000 - $130,000 a year
- Full-time
- Microsoft Outlook
- 5 years
- Office
- Health insurance
- Dental insurance
Medical Social Worker (MSW) Home Health - Miami, FL
Senior Care Solutions —Miami Lakes, FL
- PRN
- Master of Social Work
- Mid-level
- Driver's License
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Case Management Assistant
HCA Florida Westside Hospital —Plantation, FL
- Full-time
- 2 years
- Entry level
- Employee stock purchase plan
- Disability insurance
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Senior Grant Management Specialists
Jefferson Solutions Group —Miami, FL
- Full-time
- Hybrid work
- 8 years
- Bachelor's degree
- Training & development
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Senior Manager, Loyalty Transformation
Royal Caribbean Group —Miami, FL
- Microsoft Word
- Writing skills
- Office
12d
Junior Financial Operations Analyst
East Harbor —Miami, FL
- $50,000 - $75,000 a year
- Full-time
- Computer Science
- Research
- Office
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Senior Business Analyst
Visa International Service Association —Miami, FL
- $109,800 - $175,700 a year
- Full-time
- Hybrid work
- Office
- Finance
- Analysis skills
- Wellness program
- Health savings account
Quick Apply
5d
Senior Leave and Accommodation Specialist
Chewy —Plantation, FL
- Full-time
- Experience working with individuals with disabilities
- Mid-level
- Bachelor's degree
13d
Senior Manager, Medical Education (United REMOTE)
Cordis —Miami Lakes, FL
- Full-time
- Remote
- 11+ years
- Education
- Bachelor's degree
Sr Manager, FOCUS
Gilead Sciences —Miami, FL
- $143,225 - $185,350 a year
- Full-time
- 6 years
- Residential
- Master's degree
- Health insurance
- Dental insurance
Senior Financial Investigator
Contact Government Services, LLC —Miami, FL
- $74,156.16 - $107,114.45 a year
- Full-time
- Hybrid work
- Mid-level
- Driver's License
- Presentation skills
- Health insurance
- Dental insurance
Quick Apply
Financial Aid Service Specialist, FAME
Aquila Software Group —Pembroke Pines, FL
- Remote
- School experience
- Mid-level
- Continuous improvement
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Records Specialist (City of Pembroke Pines Police Department)
FC SERVICES LLC —Pembroke Pines, FL
- $20 an hour
- Full-time
- Basic math
- English
- Office
- Disability insurance
- Health insurance
Quick Apply
3d
Senior Director of eDiscovery
Contact Government Services, LLC —Miami, FL
- $161,279.04 - $232,958.61 a year
- Overtime
- Hybrid work
- 7 years
- Team management
- Senior level
- Health insurance
- Dental insurance
Quick Apply

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senior case jobs near miami lakes, fl

Quality Accreditation Coordinator

Solis Health Plans -
Doral, FL

Quick Apply

Job Details

Full-time
$25 - $30 an hour

Qualifications

Spanish
Spreadsheets
Microsoft Office
Health insurance knowledge
Desktop applications
Data-driven problem-solving
Data analytics technologies

Full Job Description

POSITION SUMMARY

The Quality and Accreditation Coordinator supports the organization's quality improvement, regulatory compliance, and NCQA accreditation activities. This role is responsible for assisting the Director of Quality Operations in coordinating quality programs, monitoring performance measures, supporting NCQA health plan accreditation surveys, maintaining required documentation, and collaborating with internal departments to ensure compliance with federal, state, and NCQA health plan accreditation standards. The coordinator assists in driving continuous quality improvement initiatives that improve member outcomes, operational performance, and health plan effectiveness.

Position is onsite Monday-Friday.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Review and analyze data across various areas, including claims, authorizations, grievances, appeals, case management, network adequacy, membership composition, and other related fields.
Assist with QOC investigation, QIC Prep, monitoring, and auditing.
Supports with preparation of evidence files and documentation for NCQA health plan accreditation surveys.
Collects reporting for measurement and benchmarking of performance measures in relation to best practices for NCQA, CMS, and internal business objectives.
Ensures data is accurate, reliable, and reported timely.
Collects performance indicator reports and benchmark narratives for review by Director of Quality Operations for performance improvement recommendations.
Assists with monitoring quality performance, outcomes, and/or metrics to make recommendations for targeted process improvement projects.
Prepares overviews and interpretation of reports; and following up on assigned action items for various projects, meetings, and committees.
Assists with accreditation and quality-related education to staff as needed.
Assists with problem analysis for strategic planning initiatives.
Solves data integrity issues as they arise, and monitor the addition of new data, analytics, and reporting systems.
Assist with interpretation and translation of data for senior management for use in meaningful decision making, and strategic planning purposes.
Assists with internal and external audits and preparation of audit responses.
Collects supporting documentation to support review of Quality-of-Care concern investigations.

QUALIFICATIONS AND EDUCATION

HS Diploma required or Associate's degree in Healthcare Administration, Nursing, or related field.
2+ years of experience in managed care, Medicare, Medicaid, or health plan setting.
Bilingual in English and Spanish.
Relevant experience may substitute for the educational requirement on a year-for-year basis.
Experience with NCQA health plan accreditation standards
Knowledge of federal regulations and industry standards.
Strong data analytical and problem-solving skills.
Excellent communication and documentation abilities.
Attention to detail with a focus on data integrity.
Experience using Microsoft applications.
Expert knowledge in Excel.

WORKING CONDITIONS

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The noise level in the work environment is usually moderate.
Fast-paced office environment.
Highly regulated environment.
Interacts with patients, family members, staff, visitors, government agencies, etc., under a variety of conditions and circumstances.

This work requires the following physical activities: climbing, bending, stooping, kneeling, reaching, sitting, standing, walking, lifting, finger dexterity, grasping, repetitive motions, talking, hearing and visual acuity. The work is performed indoors. Sits, stands, bends, lifts, and moves intermittently during working hours. May be sitting for a prolonged period.

The work schedule is approximate, and hours/days may change based on company needs. All full-time employees are required to complete forty (40) hours per week as scheduled, including weekends and holidays as needed. May require some OT during varying seasons of the year.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

The employee must be able to frequently lift up to 10 pounds and occasionally lift and/or move up to 25 pounds. While performing the duties of this job, the employee is regularly required to talk or listen. The employee is frequently required to stand and walk. The employee is occasionally required to use hands to finger, handle, or feel; reach with hands and arms; climb or balance and stoop, kneel, crouch, or crawl. Specific vision abilities required for this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.

PERFORMANCE MEASUREMENTS

Duties accomplished at the end of the day/month.
Attendance/punctuality.
Compliance with Company regulations.
Safety and Security.
Quality of work.

This Job Description may be modified at any time at the discretion of the employer as business operations may deem necessary. This does not constitute an employment agreement and may not include all duties.

The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required of personnel so classified. The incumbent must be able to work in a fast-paced environment with a demonstrated ability to juggle and prioritize multiple competing tasks and demands and to seek supervisory assistance as appropriate.

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Refine Your Search

senior case jobs in miami lakes, fl

Quality Accreditation Coordinator

Senior Investigator, Special Investigations Unit (Aetna SIU) - Must reside in Florida

Senior Paralegal

Sr RN - Optum Infusion

Senior Civil Rights Specialist

Senior Analyst - Payments

Finance - Administrative Assistant

Medical Social Worker (MSW) Home Health - Miami, FL

Case Management Assistant

Senior Grant Management Specialists

Senior Manager, Loyalty Transformation

Junior Financial Operations Analyst

Senior Business Analyst

Senior Leave and Accommodation Specialist

Senior Manager, Medical Education (United REMOTE)

Sr Manager, FOCUS

Senior Financial Investigator

Financial Aid Service Specialist, FAME

Records Specialist (City of Pembroke Pines Police Department)

Senior Director of eDiscovery

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