Sunshine State Health Plan jobs in Sunrise, FL

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Long Term Care Coordinator II (Miami-Dade)
Home health, discharge planning, or long term care experience preferred. Collaborate with discharge planners, physicians, and other parties to ensure...
Desired:Driver's License
Prior Authorization Nurse I
Current State LPN/LVN or RN license. Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of...
Desired:Managed CareNursing ExperienceRN
Supervisor, Quality Improvement
LPN/LVN or RN license without restriction in the state of residence. Prepare any applicable department state, federal, or accrediting body reports and submit...
Desired:Managed CareRNMicrosoft Office

Program Coordinator II

Sunrise, FL
Helps develop marketing and outreach meetings as directed to represent the health plan. Attends marketing and outreach meetings as directed to represent the...
Desired:Managed Care

Data Integrity Specialist

Sunrise, FL
Coordinate provider data between the health plan database and external provider database. Investigate issues and coordinate efforts between the health plan and...

Business Analyst II

Sunrise, FL
Perform various analysis and interpretation to link business needs and objectives for assigned function Support business initiatives through data analysis,...
Desired:ExcelSQLData AnalysisMicrosoft Access

Supervisor, Program Coordination

Sunrise, FL
Develop plan specific literature and educational components for member and provider distribution. Perform collaborative duties for the development and...

Compliance Auditor (Non Clinical)

Sunrise, FL
Perform operational and compliance risk based audits for the health plan. Develop schedule and perform health plan audits and specialty care company...
Desired:Medical Coding Certification

Prior Authorization Nurse I

Sunrise, FL
Current State LPN/LVN or RN license. Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of...
Desired:Managed CareNursing ExperienceRN

Risk Adjustment Coding Analyst

Sunrise, FL
High school diploma or equivalent and 2+ years of medical coding, risk adjustment coding or Hierarchical Condition Category (HCC) coding experience in the...
Desired:SQLMicrosoft WordMicrosoft PowerpointMicrosoft Office

Claims System Specialist

Sunrise, FL
Submit CRs for necessary updates to ensure compliance with State Medicaid rules. Update and review fee schedule from the State and ensure payment is aligned...
Desired:Managed Care

Quality Improvement Analyst.

Sunrise, FL
Develop and update quarterly, annual and ad hoc reports including analysis and narrative for NCQA accreditation and Health Plan deliverables....
Desired:NCQA StandardsCPHQManaged CareMicrosoft Office

Medical Coordinator- Broward

Fort Lauderdale, FL 33309
Serving as a liaison between client services, CBCIH and Sunshine Health. Assist in the development of the client’s care plan....
Desired:Driver's License
Clinical Appeals Coordinator
Maintain current knowledge of NCQA and State regulations. 3+ years of experience providing therapy services in healthcare or home health settings....
Desired:Case ManagementManagement ExperiencePhysical Therapy LicenseCCC-ANCQA Standardsand 3 more...
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