- AdventHealth (Maitland, FL)
- …care issues by collecting and interpreting contract performance information (eg claims volumes, quality and efficiency reports, participation gap analysis, ... and operational issues related to accounts receivable, utilization management, quality assurance, billing, pre-access, care management, and other related issues… more
- Healthfirst (FL)
- …and consumable information to department leaders. + Define and implement metrics, quality benchmarks and related analysis on performance and service levels to inform ... within any area of operations (Member Services, Enrollment & Billing, Claims , Provider Services, etc.). + Experience with database reporting and automation,… more
- Jacobs (Fort Lauderdale, FL)
- …and contracts * Aligned PM Performance * Operational governance, process adherence and quality * Claims against the company * New sales opportunities KEY ... (project managers and/or construction managers), technical acumen, financial, schedule and quality control, commercial and risk management to meet project and… more
- USAA (Tampa, FL)
- …and design methodologies, eg Six Sigma and Lean, business operations, risk management, quality assurance and control, or internal audit (in addition to the minimum ... years of experience required) may be substituted in lieu of degree. + 8 years business process execution/knowledge/experience, consulting, and/or process engineering/optimization. + 3 years of direct team lead, supervisory or management experience. +… more
- Molina Healthcare (FL)
- …+ Knowledge of healthcare operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) + Knowledge of healthcare ... executive decision-making + Mine and manage information from large data sources. + Analyze claims and other data sources to identify early signs of trends or other… more
- Molina Healthcare (FL)
- …+ Knowledge of healthcare operations (utilization management, disease management, HEDIS quality measures, claims processing, etc.) + Knowledge of healthcare ... executive decision-making + Mine and manage information from large data sources. + Analyze claims and other data sources to identify early signs of trends or other… more
- AdventHealth (Tampa, FL)
- …the Physician Advisor is responsible for providing clinical review of utilization, claims management, and quality assurance related to inpatient care, outpatient ... in support of medical management programs, promoting the delivery of high quality , patient focused and cost-effective medical care. **The value you'll bring to… more
- Centene Corporation (Orlando, FL)
- …years of managed care or medical group experience, provider relations, quality improvement, claims , contracting utilization management, or clinical operations. ... for issue resolution. Drive optimal performance in contract incentive performance, quality , and cost utilization. + Serve as primary contact for providers… more
- Centene Corporation (Tallahassee, FL)
- …of recommendations to providers that would improve utilization and health care quality . + Reviews claims involving complex, controversial, or unusual or ... the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit. + Provides medical… more
- Centene Corporation (New Port Richey, FL)
- …years of managed care or medical group experience, provider relations, quality improvement, claims , contracting utilization management, or clinical operations. ... for issue resolution. Drive optimal performance in contract incentive performance, quality , and cost utilization. + Serve as primary contact for providers… more