- Otsuka America Pharmaceutical Inc. (Tallahassee, FL)
- …and every day. **Position Overview:** The Director of Field Strategy and Operations serves as the orchestrator of field strategy, ensuring that prioritization, ... federal laws, regulations and guidelines including PhRMA Code on Interactions with Healthcare Professionals as well as complying with all OAPI standards and policies… more
- Molina Healthcare (Jacksonville, FL)
- …The Operational/Regulatory Oversight Sr. Analyst works with health plans and operations departments to assess, oversee, and recommend business practices to ensure ... Analyst develops and performs audits and oversight functions involving business-critical operations and vendor outsourcing arrangements for the company. The Sr.… more
- DOCTORS HEALTHCARE PLANS, INC. (Miami, FL)
- …Improvement initiatives. This role ensures effective care coordination, promotes quality healthcare delivery, manages healthcare costs, and ensures compliance ... goals and objectives. Key Responsibilities: + Lead and manage the day-to-day operations of the Medical Management department, ensuring the delivery of high-quality,… more
- Humana (Tallahassee, FL)
- …and help us put health first** The Associate VP, Resolution- CTM Oversight and Operations will serve as a strategic leader overseeing initiatives to improve CMS STAR ... ratings and manage Complaint Tracking Metrics (CTMs) across insurance operations . This role is responsible for driving process improvements, ensuring compliance, and… more
- Walgreens (Mims, FL)
- …when using the pharmacy. Enhances customer experience by increasing focus on healthcare services. ** Operations ** + Responsible for assisting pharmacist in the ... federal laws/regulations allow, accountable for performing day-to-day non-clinical pharmacy operations , administrative activities; Ensures efficient pharmacy workflow and a… more
- Molina Healthcare (Orlando, FL)
- …as necessary to debug/analyze problems. + Fields direct questions from Molina Operations Staff regarding business, technical and operations rules. + Develops ... + SQL expertise + Excel expertise + Medicare, Medicaid, Marketplace claims expertise **PHYSICAL DEMANDS:** Working environment is generally favorable and lighting… more
- Molina Healthcare (St. Petersburg, FL)
- …rejections. Address a variety of enrollment questions or concerns received via claims , call tracking, or e-mail. Maintain records in the enrollment database. ... audits as needed + Participate in process improvement initiatives to improve operations + Understands the compliance and regulatory guidelines for each state +… more
- Molina Healthcare (Jacksonville, FL)
- …pharmacy prior authorization requests and/or appeals. + Explains Point of Sale claims adjudication, state, NCQA, and CMS policy/guidelines, and any other necessary ... and pharmacies. + Assists with clerical services/tasks and other day-to-day operations as delegated. + Effectively communicates plan benefit information, including… more
- CVS Health (Tallahassee, FL)
- …sponsors' benefit requirements and facilitate the design and implementation of customized healthcare benefit plans. + Provide expert advice and guidance on benefit ... compliance impacting plan sponsors. + Collaborate with internal departments-including claims , customer service, and client management-to ensure effective issue… more
- AdventHealth (Maitland, FL)
- …timely. **The expertise and experiences you'll need to succeed:** + 3 years Healthcare , Managed Care, Hospital or Ancillary claims analysis, Hospital or ... claims payment, or related field with bachelors degree + 5 years Healthcare , Managed Care, Hospital or Ancillary claims analysis, Hospital or Ancillary … more