44 Results for

Hedis Review Nurse Jobs in Florida

Jobs

Lauderhill, FL8 days ago

$118,062–$168,658

Operating under a collaborative practice agreement, this role focuses on reducing polypharmacy, enhancing medication adherence, and managing chronic diseases to improve patient outcomes and elevate quality performance metrics such as CMS Star Ratings and HEDIS scores. The ambulatory pharmacist partners closely with patients, physicians, advanced practice providers, nurses, and care teams to deliver evidence-based, individualized care that promotes safety, efficacy, and cost-effectiveness.

Miami, FL8 days ago

$128,686–$183,837

Operating under a collaborative practice agreement, this role focuses on reducing polypharmacy, enhancing medication adherence, and managing chronic diseases to improve patient outcomes and elevate quality performance metrics such as CMS Star Ratings and HEDIS scores. Medication Management & Optimization: Collaborates with healthcare providers to adjust medication therapies, interpret lab results, and support clinical decision-making within a protocol-driven framework.

New!

Durant, FL1 day ago

$72,800–$130,000 Per Year

WellMed has more than 22,000+ primary care physicians, hospitalists, specialists, and advanced practice clinicians who excel in caring for 900,000+ older adults. This role is designed to drive value-based care performance and reduce avoidable utilization through proactive patient outreach, coordinated clinical interventions, and improved provider engagement.

West Palm Beach, FL9 days ago

Humana’s Primary Care Organization is one of the largest and fastest growing value-based care, senior-focused primary care providers in the country, operating multiple centers across eight states under two brands: CenterWell & Conviva. As the nation’s largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients.

Winter Haven, FL30+ days ago

Work closely with PCP to manage patient "care items" which could include; medication refills per protocol, lab triage, document management, management of durable medical equipment (i.e. Glucometer, test strips, lancets), prior authorizations of needed medications or other services. Primary Duties include, but are not limited to, the following: Assess, identify problems, plan goals, monitor and evaluate patient plans, and develop strategies that meet the patients immediate and long-term goals.

Plantation, FL30+ days ago

Remote

$78,500–$90,000 Per Year

Regularly sits at a desk during scheduled shift, uses office phone or headset provided by the Company for phone calls, making outbound calls and answering inbound return calls using an office phone system; views a computer monitor, types on a keyboard and uses a computer mouse. Deployed by over 75 health plans, including many of the top 20, and representing more than 170 million lives, Machinify's AI operating system, combined with proven expertise, untangles healthcare data to deliver industry-leading speed, quality, and accuracy.

Plantation, FL30+ days ago

Remote

$81,000–$90,000 Per Year

Tampa, FL30+ days ago

Remote

Full-time

The team lead supports clinical and non-clinical staff supporting CQM programs by providing training and onboarding of new staff; determining work assignments; performing audits for clinical records and/or work accuracy; and ensuring effective, consistent and accurate workflow. Technical Skills: Comprehensive knowledge of research methodology; proficient applying appropriate data analysis processes; knowledge of managed care principles and methods; knowledge in the application of clinical criteria; proficient with Microsoft Word, Excel, and PowerPoint.

PALMETTO, FL30+ days ago

Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom. This role helps drive quality best practices in a collaborative effort with payers, providers, support staff, managed care, VBC leaders and administration.

FL24 days ago

Remote

At least 3 years of experience in a health education-related capacity, and at least 1 of year experience working with a wide range of member populations within a managed care setting, or equivalent combination of relevant education and experience. May serve as the designated QI representative at various external activities to include immunization, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT), chronic condition collaborative and other work group meetings.

west palm beach, FL30+ days ago

$70,000–$90,000 Per Year

Ability to travel to other locations to attend meetings, workshops, and seminars, plus travel to other FoundCare departments and FoundCare conference rooms. Full range of body motion: Position requires reaching, bending, stooping, and handling objects with hands and/or fingers, talking and/or hearing, and seeing.

Sunrise, FL11 days ago

$38–$43 Per Hour

This role focuses on intake assessments, individualized care planning, discharge coordination, and ongoing monitoring of clinical outcomes, with a strong emphasis on documentation, care coordination, and quality improvement. The environment is mission-driven and focused on improving maternal and child health outcomes across Florida, offering flexibility, training opportunities, and a supportive culture that values professional growth, collaboration, and measurable impact on community health.

New!

Tampa, FL6 days ago

Under the direct supervision of the Health Center Manager and in-direct clinical supervision of Nursing Administration, the Clinical Services Supervisor (CSS) shall perform licensed nursing duties under scope of practice, oversee back office clinical competency and performance, maintain and operate medical and laboratory equipment, assist in the treatment and care of patients, including performing physically demanding assignments. Coordinates with the Care Team (Primary Care Provider, Health Educator, Registered Dietitian, RN, Behavioral Health Provider, Director of Nursing, or Medical Director) to ensure appropriate services are arranged for the patient in order for the patient to meet his/her care goals.

Kissimmee, Florida11 days ago

$2,400–$10,000 Per Year

Ability to practice autonomously in a remote clinical environment, including independently conducting patient assessments, formulating evidence-based treatment plans, managing complex chronic conditions, and making sound clinical decisions without direct on-site supervision. Pay Range: $2,400.00 - $10,000.00 per month (Potential income) Earnings will vary based on completed assessments, state of residence, and business needs as there is no guarantee of visits or minimum income.

Orlando, FL30+ days ago

You’ll work closely with a registered nurse and collaborate with each patient’s primary care provider to identify red flags, manage chronic conditions, and keep patients healthy at home. By providing your phone number, you consent to: (1) receive automated text messages and calls from the Judge Group, Inc. and its affiliates (collectively "Judge") to such phone number regarding job opportunities, your job application, and for other related purposes.

Clearwater, FL30+ days ago

$123,800–$170,300 Per Year

As 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. Humana''s Primary Care Organization is one of the largest and fastest growing value-based care, senior-focused primary care providers in the country, operating multiple centers across eight states under two brands: CenterWell & Conviva.

FL24 days ago

Remote

New!

Tampa, FL3 days ago

$38–$43 Per Hour

Jacksonville, FL30+ days ago

$21–$35 Per Hour

Performs FEP Member outreach on selected HEDIS® medication measures to educate patients and caregivers on the appropriate use of medications, referring members to FEP MTM Pharmacist for more in-depth medical questions related to prescriptions. Job Summary: The FEP Quality Pharmacy Technician is a member of the Federal Employee Program (FEP) Quality team and will work with internal and external partners on clinical quality improvement initiatives related to FEP-HEDIS®.

Miami, FL30+ days ago

Assist Medical Providers with medical procedures/testing by performing: • Electrocardiogram (EKG's), vision and hearing test, diabetic, foot/monofilament test, fall risk assessment (65 & over), waived testing, results documentation & log Maintenance (blood glucose, A1C, strep, urine dipstick, urinalysis, pregnancy, Immunochemical Fecal Occult Blood Test (iFOBT), influenza A&B). Assist Medical Providers with procedures/testing and ensures proper documentation in medical record: • Pap smear, colposcopy, biopsy, vaginal cultures, pelvic/breast exam, male exam, incision and drainage, throat cultures, nebulizer treatments and other procedures as indicated by the provider.

The Villages, FL12 days ago

Full-time

Associate Medical Director Role Overview:Leadership and Organizational Management:Identify and monitor clinical risks that could otherwise impact the organization financially or operationally, through collaboration with Care Center Medical Directors and clinical operations and under the direction of the Market CMO. As 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.

Tampa, FL30+ days ago

$72,800–$130,000 Per Year

The fraudulent LinkedIn messages and emails, which do not originate from any Executives LinkedIn account or of UnitedHealth Group's email domains, or those of any of its operating divisions, supposedly conducts an interview via a Zoom meeting, offers a work from home job at Optum, emails an application, sends a fake check by next day delivery through USPS and asks recipients to pay a vendor a large dollar amount. WellMed has more than 22,000+ primary care physicians, hospitalists, specialists, and advanced practice clinicians who excel in caring for 900,000+ older adults.

Miami, FL21 days ago

$118,062–$168,658 Per Year

Operating under a collaborative practice agreement, this role focuses on reducing polypharmacy, enhancing medication adherence, and managing chronic diseases to improve patient outcomes and elevate quality performance metrics such as CMS Star Ratings and HEDIS scores. ESSENTIAL JOB DUTIES/RESPONSIBILITIES: Medication Management & Optimization: Collaborates with healthcare providers to adjust medication therapies, interpret lab results, and support clinical decision-making within a protocol-driven framework.

Jacksonville, FL30+ days ago

$128,686–$183,837 Per Year

Operating under a collaborative practice agreement, this role focuses on reducing polypharmacy, enhancing medication adherence, and managing chronic diseases to improve patient outcomes and elevate quality performance metrics such as CMS Star Ratings and HEDIS scores. Medication Management & Optimization: Collaborates with healthcare providers to adjust medication therapies, interpret lab results, and support clinical decision-making within a protocol-driven framework.

Maitland, FL13 days ago

$19.22–$35.75 Per Hour

Documents in the upcoming patient encounter all necessary information relevant to the appointment, including suspect conditions, screenings, specific care gaps to be addressed at the visit, initiates orders as needed, updates health maintenance topics, and provides any other key information obtained in the pre-visit planning stage. Outreaches patients to complete health risk assessments, follows up on open orders, reviews medications, assesses social determinants of health, schedules/reschedules appointments as needed, and attempts to obtain any outside records for care gap closure and continuity.

Miami, FL30+ days ago

Part-time

Assist Medical Providers with medical procedures/testing by performing: Electrocardiogram (EKG’s), vision and hearing test, diabetic, foot/monofilament test, fall risk assessment (65 & over), waived testing, results documentation & log Maintenance (blood glucose, A1C, strep, urine dipstick, urinalysis, pregnancy, Immunochemical Fecal Occult Blood Test (iFOBT), influenza A&B). Assist Medical Providers with procedures/testing and ensures proper documentation in medical record: Pap smear, colposcopy, biopsy, vaginal cultures, pelvic/breast exam, male exam, incision and drainage, throat cultures, nebulizer treatments and other procedures as indicated by the provider.

New!

Cape Coral, FL4 days ago

Monogram Health employs a robust clinical team, leveraging specialists across multiple disciplines including nephrology, cardiology, endocrinology, pulmonology, behavioral health, and palliative care to diagnose and treat health issues; review and prescribe medication; provide guidance, education, and counselling on a patient's healthcare options; as well as assist with daily needs such as access to food, eating healthy, transportation, financial assistance, and more. Reporting to the Region President, the Market Physician Executive (MPE) is a key clinical leader within Monogram Health who contributes to the development and oversight of clinical strategies, policies, programs, processes, protocols, guidelines, and operations that drive improved patient health outcomes within the market.

Orlando, FL21 days ago

$43,000–$56,200 Per Year

Medical Assistant Role Overview: The Medical Assistant performs clinical duties such as discussing symptoms, obtaining vital signs, medication/vaccine administration, phlebotomy, collecting specimens, performing diagnostic screening tests, sterilizing/cleaning equipment, maintaining examination rooms, and documenting information into the electronic medical records system. As 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.

Stuart, FL30+ days ago

Role and Responsibilities: Screens patients according to FCHC protocols (i.e. obtaining vital signs, height, weight, vision/hearing testing) and any other procedures directed by the supervising provider/Clinical Coordinator, or Clinical Support Leaders. Performs in\u2010house waived testing, after they are quality controlled, which may include some or all of the following: pregnancy tests, hemocue/Hemoglobin, glucometer, urine dip, hemoccult\u2010stool, oraquick, or throat swab.

New!

Tampa, FL1 day ago

Part-time

Monogram Health employs a robust clinical team, leveraging specialists across multiple disciplines including nephrology, cardiology, endocrinology, pulmonology, behavioral health, and palliative care to diagnose and treat health issues; review and prescribe medication; provide guidance, education, and counselling on a patient’s healthcare options; as well as assist with daily needs such as access to food, eating healthy, transportation, financial assistance, and more. Reporting to the Region President, the Market Physician Executive (MPE) Float is a key clinical leader within Monogram Health who contributes to the development and oversight of clinical strategies, policies, programs, processes, protocols, guidelines, and operations that drive improved patient health outcomes within the market.

New!

Cape Coral, FL1 day ago

Part-time

Monogram Health employs a robust clinical team, leveraging specialists across multiple disciplines including nephrology, cardiology, endocrinology, pulmonology, behavioral health, and palliative care to diagnose and treat health issues; review and prescribe medication; provide guidance, education, and counselling on a patient’s healthcare options; as well as assist with daily needs such as access to food, eating healthy, transportation, financial assistance, and more. Reporting to the Region President, the Market Physician Executive (MPE) is a key clinical leader within Monogram Health who contributes to the development and oversight of clinical strategies, policies, programs, processes, protocols, guidelines, and operations that drive improved patient health outcomes within the market.

Keystone Heights, FL25 days ago

Completes all documentation including medical charts as appropriate according to the medical records system and government regulations, including sexually transmitted diseases Cleans and sterilizes x-ray/radiology equipment. Responsible for a variety of tasks assisting patients and providing basic in-take tests and services; assists providers with direct patient care as directed.

Palatka, FL30+ days ago

New!

Pompano Beach, FL1 day ago

Track referral patterns and help guide patients to in-network or preferred providers aligned with Accountable Care Organizations (ACOs) and narrow network strategies. The Referral Coordinator plays a vital role in supporting patient care coordination by managing insurance pre-verifications, referral processing, appointment scheduling, and communication between patients, providers, and health plans.

Tampa, FL30+ days ago

The Medical Pod Leader will be the clinical leader responsible for the clinical performance of clinical pod team members - to include: Accurate diagnosis and documentation, quality, patient experience, affordability, patient safety, clinical team dynamics, and provider productivity. Collaborate with clinical team members associated with pod (Community Health Workers, Medical Social Workers, Nurse Navigators, Care Managers, Patient Care Coordinators, etc.).

Tampa, Florida30+ days ago

Responsibilities: The Medical Pod Leader will be the clinical leader responsible for the clinical performance of clinical pod team members – to include: Accurate diagnosis and documentation, quality, patient experience, affordability, patient safety, clinical team dynamics, and provider productivity. Collaborate with clinical team members associated with pod (Community Health Workers, Medical Social Workers, Nurse Navigators, Care Managers, Patient Care Coordinators, etc.).

Vero Beach, FL13 days ago

Responsible for the day-to-day operation of a multi-specialty medical clinic, to include planning and coordinating the work assignments of clinical staff and collaborating as necessary with Managers supervising non-clinical staff (i.e., front desk, Pharmacy, social services). Knowledgeable about provider specialties, FQHC regulations, services available to all patients as resources including but not limited to sliding fee scale eligibility, social service programs, Pharmacy services.

Palm Bay, FL11 days ago

Haines City, FL30+ days ago

Full-time

Founded in 2013, Palm Medical Centers is a provider of value-based, capitated primary care services with a focus on high-quality clinical outcomes, cost-effective care, and a patient-centric experience. Collaborate closely with care teams including nurse practitioners, medical assistants, case managers and specialists to insure seamless patient care.

Tampa, FL27 days ago

$150,000–$160,000

Join a fast-growing healthcare organization improving care gap performance across telehealth and in-home care. Help scale compliant, defensible care gap programs across distributed clinical teams.

FL24 days ago

Remote

Clearwater, Florida21 days ago

Fort Myers, FL30+ days ago

Reporting to the Region President, the Market Physician Executive (MPE) Float is a key clinical leader within Monogram Health who contributes to the development and oversight of clinical strategies, policies, programs, processes, protocols, guidelines, and operations that drive improved patient health outcomes within the market. The MPE Float oversees the daily clinical and business operations through delivery of direct patient care, care management services, social worker support and pharmacy services within the market.

Clearwater, FL20 days ago

By combining data-driven insights with three decades of industry relationships, CCS is the smart choice for health plans, providers, employers, and manufacturers who believe that value-based care starts by keeping patients healthy and delivers benefits like lower cost of care, improved HEDIS scores, and alleviating provider burnout. Position Summary: Success in this role will perform general Pharmacist duties, including but not limited to: preparing medications, completing final check on filled medications, review and approval on data entry of prescriptions, monitoring patient drug therapies and drug utilization reviews.

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Hedis Review Nurse Jobs in Florida

Ambulatory Pharmacist ChenMed

Regional Manager, Ambulatory Pharmacist ChenMed

Senior Practice Support Specialist Optum

Primary Care Physician Conviva Senior Primary Care

HEDIS Utilization Review Nurse Central Florida Health Care, Inc.

Medical Review Nurse - Home Health Auditor Performant Healthcare Inc

Medical Review Nurse - CMS RAC (Government audits) Performant Healthcare Inc

Clinical Quality Review Team Lead TriWest Healthcare Alliance

RN / QUALITY MANAGER University Health Services Inc

Senior Health Educator- Pediatric Mental Health Nurse - Remote Molina Healthcare Inc

Quality Nurse Manager FOUNDCARE INC.

OB Case Manager RN Actalent Inc

Clinical Services Supervisor, RN Community Health Centers of the Central Coast

Nurse Practitioner (Per Diem) ComplexCare Solutions

Nurse Practitioner - Orange County, FL Judge Group

Nurse Practitioner Clearwater and Dunedin, FL Humana Inc

Senior Health Educator- Clinical Transplant Nurse- Remote Molina Healthcare Inc

RN Case Manager Actalent Inc

FEP Pharmacy Technician GuideWell Mutual Holding Corp

PATIENT CARE ASSISTANT- BH Care Resource Community Health Centers, Inc.

Associate Medical Director CenterWell Senior Primary Care

Senior Practice Support Specialist UnitedHealth Group Inc

Ambulatory Pharmacist ChenMed LLC

Regional Manager, Ambulatory Pharmacist ChenMed LLC

Quality & Value Clinical Specialist - LPN-PHSO AdventHealth

PATIENT CARE ASSISTANT- BH Care Resource Community Health Center

Market Physician Executive (MPE) Monogram Health Inc

Medical Assistant Humana Inc

Medical Assistant Florida Community Health Centers Inc

Market Physician Executive (MPE) - Float Monogram Health Professional Services

Market Physician Executive (MPE) Monogram Health Professional Services

X-Ray/MA (Keystone Heights) Aza Health

X-Ray/MA (Palatka) Aza Health

Coordinator, Referrals Cano Health

Physician Lead Primary Care - Tampa or Orlando HarmonyCares.

Physician Lead Primary Care - Tampa or Orlando HarmonyCares

Office Manager Manpower - South Florida

Coordinator, Referrals Cano Health Inc

Primary Care Physician Palm Medical Centers

Director of Clinical Performance – Care Gap Closure & Integrity Urrly

Senior Health Educator- Pediatric Critical Care RN- Remote Molina Healthcare Inc

Staff Pharmacist CCS

Market Physician Executive (MPE) - Float Monogram Health

Staff Pharmacist CCS Medical Holdings, Inc.

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