- Evolent (Tallahassee, FL)
- …Computer Proficiency . Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified ... the culture. **What You'll Be Doing:** As a Field Medical Director, Oncology, you will be a key member...the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization Review… more
- Humana (Tallahassee, FL)
- …Nurse roles and responsibilities include but are not limited to: + Completes medical necessity and level of care reviews for requested services using clinical ... for review depending on case findings. Educates providers on utilization and medical management processes. + Enters and maintains pertinent clinical information in… more
- Evolent (Tallahassee, FL)
- …Computer Proficiency + Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified ... Stay for the culture. **What You'll Be Doing:** The Medical Director for MSK Surgery is a key member...General Service Administration (GSA), or reprimanded or sanctioned by Medicare . + No history of a major disciplinary or… more
- Humana (Tallahassee, FL)
- …associates have met all training requirements for company, quality, and regulatory compliance . + Analyzes course evaluations in order to judge the effectiveness of ... to learn different processes + Bilingual in English/Spanish + Experience with Medicare + Healthcare experience + CGX experience **Additional Information** + **WAH**… more
- CenterWell (Tallahassee, FL)
- …an in-depth understanding of the healthcare industry, including value-based care, Medicare , population health, Accountable Care Organizations (ACOs), medical ... with healthcare industry including value-based care, health plans, health systems, Medicare , accountable care, population health, medical group management /… more
- USAA (Tampa, FL)
- …benefit structures within the health insurance industry, Medicare or Medicare Supplement preferred. + Proficient knowledge of medical claims coding ... and other agencies as appropriate.As a Mid-Level Life SIU Investigator for ** Medicare Supplement Fraud, Waste, and Abuse** you will support the Life Special… more
- Kestra Medical Technologies, Inc (Orlando, FL)
- …team has over 400 years of experience in the external and internal cardiac medical device markets. The company was founded in 2014 by industry leaders inspired by ... the care team of process and training for patient compliance and experience. . Link the SWO renewal process...or business . Minimum 2 years industry experience in medical device, pharmaceuticals, or a comparable healthcare setting .… more
- CenterWell (Jacksonville, FL)
- …part of our caring community and help us put health first** The Associate Medical Director (AMD) is an instrumental clinical leader of our primary care team, ... (clinical, financial, operational) meetings on key topics such as Medical Risk Adjustment (MRA), budgeting, staffing, operational excellence, and clinical… more
- CenterWell (Tallahassee, FL)
- …a Medicare certified home health agency. + A thorough knowledge of federal regulations and Medicare requirements is required along with analytical skills to ... + Responsible for constructing response to denials and appeals, utilizing any federal guidelines or local coverage determination guidelines that are applicable to… more
- CVS Health (Tallahassee, FL)
- …do it all with heart, each and every day. **Pharmacy Technician, Aetna Medicare - Work From Home** **(Aetna Medicare Pharmacy Technician)** **BUSINESS ... Advantage members' adherence to select maintenance medications informs health plans' Medicare Stars quality rating and may lead to better health outcomes.… more