- CVS Health (FL)
- …oversight of DSNP/MMP complex populations (Dual-Eligible Special Needs Plan / Medicare -Medicaid Plan) * Develop and lead clinical strategy and objectives for ... Member Outreach, Care Management, National Quality Management, Utilization Management, Compliance , and other departments to integrate social, behavioral, and… more
- Molina Healthcare (St. Petersburg, FL)
- …health portions of state contracts. * Assists behavioral health medical director lead trainers in the development of enterprise-wide education on psychiatric ... reviews and appeals. * Supports behavioral health committees for quality compliance . * Implements behavioral health specific clinical practice guidelines and medical… more
- Molina Healthcare (Miami, FL)
- …Molina Healthcare's overall mission, core values, and strategic plan and in compliance with all relevant federal, state and local regulations. Plans, organizes, ... and Joint Operating Committees. * Manages and reports network adequacy for Medicare , Marketplace, and Medicaid services. * In conjunction with direct management and… more
- Bristol Myers Squibb (Tampa, FL)
- …of a team responsible for accurate and timely Managed Care Commercial and Medicare Part D rebate processing and payments, data stewardship and compliance ... BP true-up, BP modeling of contingent/portfolio agreements, legal requests, SOX compliance , deal analytics, contract performance analytics and ad hoc data analytics… more
- AdventHealth (Altamonte Springs, FL)
- …find and implement solutions that balance strategic imperative needs while maintaining compliance with the myriad regulations. **The value you will bring to the ... outside consultants and engaging with hospital associations. + Creates solutions in compliance with regulations + Collaborates with key stakeholders to support the… more
- Molina Healthcare (Miami, FL)
- …successful launches of new processes, systems, and operational models across Medicaid, Medicare , and Marketplace lines of business. We are seeking a leader with ... + Monitoring performance and resolving operational issues to ensure continuity and compliance + Partnering with the broader corporate ecosystem to ensure strategic… more
- Trinity Health (Fort Lauderdale, FL)
- …knowledge** **of applicable Federal, state & local laws/regulations, Trinity Health Integrity & Compliance Program & Code of conduct, as well as other policies & ... a complex delivery system with a multi-specialty medical group and a Medicare Advantage health plan.** **_Position Highlights and Benefits_** + Comprehensive benefit… more
- Cardinal Health (Tallahassee, FL)
- …and proactively provides guidance and trainings on policies. Reporting to the Director , Ethics & Compliance , this position supervises and manages audits ... **_What Ethics & Compliance contributes to Cardinal Health_** Ethics & ...other appropriate staff. This position will also support the Director with transactional audit diligence and integration planning, as… more
- Option Care Health (Tampa, FL)
- …of patient care is maintained. The Nurse Manager is responsible for assisting the Director of Operations and/or Area Director of Nursing in meeting operational ... spent providing clinical patient care activities. Per state regulation requirements, the Director of Nursing title will be used. **Job Description:** **Job… more
- ChenMed (Lakeland, FL)
- …mission-driven, primary care organization, is currently one of the most successful full-risk Medicare Advantage providers in the nation and has a vision to be ... position towards becoming a center clinical P&L leader (ie, Senior Medical Director [SMD]) in the organization. The incumbent Center Medical Director … more