• Stars Program Delivery Lead - HEDIS Controlling…

    Humana (Tallahassee, FL)
    **Become a part of our caring community and help us put health first** Health Quality and Stars (HQS) is an organization that is responsible for improving ... health outcomes and advancing the care experience of our...quality as rated by the Centers for Medicare and Medicaid Services (CMS). The CMS Stars quality rating system… more
    Humana (09/03/25)
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  • Senior Human Services Program Specialist

    MyFlorida (Fort Myers, FL)
    …staff, community partners, Call Center staff, and customers to resolve policy and/or procedural questions or concerns. + Develop, interpret, coordinate, and ... Region and Operations staff. + Provide correct real time policy and procedural guidance and assistance. + Develop training...TCA, RCA and FA expertise. + Knowledge of Family Medicaid , PEPW, Child in Care, and Relative Care Giver… more
    MyFlorida (08/27/25)
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  • Stars Operations Strategy Lead

    Humana (Tallahassee, FL)
    **Become a part of our caring community and help us put health first** Health Quality and Stars (HQS) is an organization that is responsible for improving ... health outcomes and advancing the care experience of our...quality as rated by the Centers for Medicare and Medicaid Services (CMS). The CMS Stars quality rating system… more
    Humana (09/06/25)
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  • Nurse Practitioner

    CenterWell (Jacksonville, FL)
    **Become a part of our caring community and help us put health first** The Nurse Practitioner applies advanced education and clinical competencies to achieve optimal ... multidisciplinary team that includes physicians, pharmacists, care coaches, behavioral health specialists, and more-all working together to deliver personalized,… more
    CenterWell (09/04/25)
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  • Medical Record Retrieval Specialist

    Humana (Miami, FL)
    …23 years. CarePlus strives to help people with Medicare, or both Medicare and Medicaid , achieve their best possible health and wellness through plans with ... **Become a part of our caring community and help us put health first** The Medical Record Retrieval Specialist (Risk Adjustment Representative) travels to provider… more
    Humana (09/03/25)
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  • Compliance Analyst Principal - Remote

    Prime Therapeutics (Tallahassee, FL)
    …participates inclient and stakeholder meetings + Reviews proposedfederal and state public policy and rule changes and prepares position papers for internal and ... client implementations + Supports all lines of business (commercial/HIM, Medicare and Medicaid ) + Other duties as assigned **Education & Experience** + Bachelor's… more
    Prime Therapeutics (07/07/25)
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  • Stars Program Delivery Senior Professional - HEDIS…

    Humana (Tallahassee, FL)
    **Become a part of our caring community and help us put health first** Health Quality and Stars (HQS) is an organization that is responsible for improving ... health outcomes and advancing the care experience of our...quality as rated by the Centers for Medicare and Medicaid Services (CMS). The CMS Stars quality rating system… more
    Humana (09/03/25)
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  • Medical Director (Marketplace)

    Molina Healthcare (St. Petersburg, FL)
    …director, and quality improvement staff. + Facilitates conformance to Medicare, Medicaid , NCQA and other regulatory requirements. + Reviews quality referred issues, ... license without restrictions to practice and free of sanctions from Medicaid or Medicare. **PREFERRED EDUCATION:** Master's in Business Administration, Public … more
    Molina Healthcare (08/28/25)
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  • Quality Control Analyst - 1

    MyFlorida (Orlando, FL)
    …Salary: $34,760.00 - $94,348.57, in accordance with DCF salary policy Posting Closing Date: 09/12/2025 Total Compensation Estimator Tool ... adoption, domestic violence, adult protective services, refugees, homelessness, mental health , substance abuse, childcare providers, human trafficking and public… more
    MyFlorida (09/06/25)
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  • Medical Director - Medicare Grievances and Appeals…

    Humana (Tallahassee, FL)
    **Become a part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and ... clinical experience + Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products + Must be passionate about contributing to… more
    Humana (09/06/25)
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