- Elevance Health (Tampa, FL)
- **Medical Director - Florida Medicare Plans** Location: This role enables associates to work virtually full-time, with the exception of required in-person ... Florida near our Miami or Tampa locations.** The **Medical Director ** will support the following Florida Medicare ...+ Ensure timely and accurate completion of reviews in compliance with state and federal regulations, NCQA, and company… more
- Molina Healthcare (Jacksonville, FL)
- …to meet critical needs + Escalates gaps and barriers in implementation and compliance to AVP, VP and senior management + Consultative role, develops business case ... methodologies for programs, develops and coordinates implementation of business strategy + Collaborates and facilitates activities with other units at corporate and Molina Plans. **JOB QUALIFICATIONS** **Required Education** Bachelor's degree or equivalent… more
- Humana (South Miami, FL)
- …of everything it does. The MarketPoint Career Channel Team is looking for skilled Medicare Field Sales Agents. This is a field-based role, and candidates must live ... community. As part of a collaborative team of 8-12 Medicare Sales Agents, you'll work under the guidance of...under the guidance of a Senior Manager and Regional Director who are committed to your success. Together, you'll… more
- Humana (Tallahassee, FL)
- …a part of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing ... home health, SNF, DME, dual Medicare /Medicaid and Waiver requests. The Medical Director ...appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. All… more
- Humana (Tallahassee, FL)
- …health first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments ... data requires a case by case consideration of the Medicare rules, Humana policies and medical necessity. The Medical... rules, Humana policies and medical necessity. The Medical Director will collaborate with clinicians and support staff to… more
- Humana (Tallahassee, FL)
- …a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The Medical Director ... or data requires an in-depth evaluation of variable factors. The Medical Director actively uses their medical background, experience, and judgement to make… more
- Humana (Tallahassee, FL)
- …of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations ... service should be authorized. All work occurs within a context of regulatory compliance , and work is assisted by diverse resources, which may include national… more
- Humana (Tallahassee, FL)
- …of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations ... at the Inpatient level. All work occurs within a context of regulatory compliance , and work is assisted by diverse resources, which may include national clinical… more
- Humana (Tallahassee, FL)
- …of our caring community and help us put health first The Medical Director actively uses their medical background, experience, and judgement to make determinations ... service should be authorized. All work occurs within a context of regulatory compliance , and work is assisted by diverse resources, which may include national… more
- Help at Home (Coral Springs, FL)
- … compliance with federal, state, and local regulations, including Medicare Conditions of Participation where applicable, with responsibility for documentation ... and regulatory readiness reviews during geographic growth. **Qualifications** Florida HHA Director of Nursing Regulatory Responsibilities: + Ensure compliance … more