- Humana (Tallahassee, FL)
- …understanding of healthcare operations, particularly around claims processing, enrollment, provider data management and clinical operations; Medicaid ... all stakeholders are aligned and informed, including new functionality needs, data connections, adaption to changing state regulations and the like. **Reporting… more
- CVS Health (Coral Gables, FL)
- …eligibility and facilitates integrative functions using clinical tools and information/ data . + Utilizes case management processes in compliance with ... Services and strategies, policies and programs are comprised of network management , clinical coverage, and policies. **Position Summary/Mission** Community Care… more
- Grifols Shared Services North America, Inc (Miami, FL)
- …countries and regions. **Overview:** The primary responsibility of the Bleeding Management Hospital Specialty Sales Representative (HSSR) is to represent key ... products within the Bleeding Management product portfolio with a primary responsibility for the...their patients. The HSSR position requires strong sales and clinical expertise, business acumen and stakeholder relationships. The Bleeding… more
- Banner Health (FL)
- **Department Name:** IT Clinical Care-Corp **Work Shift:** Day **Job Category:** Information Technology **Estimated Pay Range:** $37.14 - $61.90 / hour, based on ... latest health care advancements and excellent patient care. The Clinical Application team supports a wide range of IT...patient experience. We support and maintain scheduling and referral management to a high standard. In this position you… more
- AdventHealth (Orlando, FL)
- …UM RN leverages the algorithmic logic of the XSOLIS Cortex platform, utilizing key clinical data points to assist in status and level of care recommendations. ... experience. + Excellent interpersonal communication and negotiation skill. + Strong analytical, data management , and computer skills. + Strong organizational and… more
- Sharecare (Tallahassee, FL)
- …nurse helps to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during ... unify and manage all their health in one place. Our comprehensive and data -driven virtual health platform is designed to help people, providers, employers, health… more
- Humana (Niceville, FL)
- …relationship across such areas as financial performance, incentive programs, quality and clinical management , population health, data sharing, connectivity, ... years of Health care or managed care with Provider Contracting, Network Management or Provider Relations experience + Proven planning, preparation and presenting… more
- Select Medical (Miami, FL)
- …Miami, FL** **$10,000 Sign-on Bonus** **Director of Quality Management ** **(DQM)** **Responsibilities** **Position Summary** Coordinates the Medical Quality ... Management and Performance Improvement activities to measurably enhance the...ensure compliance with all regulatory and accrediting standards. Collects data to monitor compliance and/or trends. + Institutes and… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …service requests. + Reviews cases referred by the prior-authorization non- clinical medical management coordinator and pre-certification technician staff ... Excel and other data entry processing applications. + Strong analytical and clinical problem-solving skills. + Ability to work OT during peak periods. ote: This… more
- Humana (Tallahassee, FL)
- …first** The UM Strategy team is a multi-disciplinary team focused on creating data -driven strategies to transform our business and the experiences we create for our ... concrete roadmaps that will generate tangible value to all stakeholders. Within Utilization Management , our goal is to enable members to receive the most appropriate… more