- Humana (Tallahassee, FL)
- …materials, internal teaching conferences, and other sources of expertise. The Behavioral Health Medical Directors will learn Medicare , Medicare Advantage and ... Medicare Advantage and Managed Medicaid products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, other… more
- CVS Health (Tallahassee, FL)
- …talent! We have an exciting opportunity available for highly motivated individuals as Medicare Sales Specialist. The position will be a part of a specialized team ... who will focus on educating existing Medicare members on available plan offerings to help meet...selling applicable products to existing members. + Maintaining high compliance commitment and standards with a robust knowledge with… more
- Humana (Tallahassee, FL)
- …a part of our caring community and help us put health first** The Corporate Medical Director (CMD) relies on medical background to review health claims and ... preservice appeals. The Corporate Medical Director works on problems of diverse scope and...necessity of services provided by other healthcare professionals in compliance with coverage policies, procedures, and performance standards. CMD… more
- Humana (Tallahassee, FL)
- …part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and preservice ... appeals. The Corporate Medical Director works on problems of diverse scope and...appropriateness of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Represents… more
- Humana (Deland, FL)
- …caring community and help us put health first** Are you passionate about the Medicare population, looking for an opportunity to work in sales, and wanting the ... the community through service, organizations, activities and volunteerism + Experience selling Medicare products + Bilingual with the ability to speak, read and… more
- Humana (Tallahassee, FL)
- …expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments involve moderately complex to complex issues where the analysis of ... situations or data requires a case-by-case consideration of the Medicare rules, Humana policies and medical necessity....policy. All work occurs within a context of regulatory compliance and work is assisted by diverse resources, included… more
- AdventHealth (Maitland, FL)
- …: Maitland, FL **The role you will contribute:** The Senior Compliance Analyst applies technical, analytical, and problem-solving skills to identify, quantify, ... and present contract compliance violations. He/she will perform extensive review of contract...will perform extensive review of contract language, state and federal regulations, and payor practices to facilitate resolution of… more
- Humana (Tallahassee, FL)
- **Become 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 provides medical interpretation and determinations whether… more
- Humana (Tallahassee, FL)
- …ensuring compliance with governmental requirements for clinics across both federal and state requirements. The work assignments involve moderately complex to ... and procedures. Research compliance issues and recommends changes that assure compliance with federal and/or state requirements related to Provider Clinic… more
- NASCO (Tallahassee, FL)
- **Overview** The Senior Corporate Counsel, Compliance & Commercial operates under general direction and is responsible for providing legal and regulatory guidance to ... and drafts complex commercial transactions, including technology agreements, and provides compliance guidance and support throughout the organization to ensure our… more