• Quality RN - Hoffner

    CenterWell (Orlando, FL)
    …+ Strong knowledge of HEDIS/Stars/CMS + Bachelor's Degree in Nursing + 3+ years of managed care experience + 3+ years of case management experience + Bilingual; ... and through in-person visits for activities such as patient education, point-of- care testing and screenings as needed (including Retinavue eye exams, HgA1c… more
    CenterWell (11/19/25)
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  • Clinical Pharmacist

    ChenMed (Hallandale Beach, FL)
    …a plus + Experience with supervising and/or supporting Pharmacy Technicians + Experience in a managed care setting (HMO, MSO, PBM) is a plus + Certified to ... your kindness and joy? We're different than most primary care providers. We're rapidly expanding and we need great...clinical pharmacist embedded within a defined market of primary care clinics. This role operates under a collaborative practice… more
    ChenMed (11/15/25)
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  • Denials Prevention Specialist, Clinician PRN

    Datavant (Tallahassee, FL)
    …payor guidelines. * **What you will bring to the table:** + Two (2) years managed care experience in UM/CM/CDI Department preferred + Knowledge of CMS, State ... government agencies, and those who deliver and pay for care . By joining Datavant today, you're stepping onto a...and necessity of continued stay in the inpatient patient care setting and/or discharge to an alternative level of… more
    Datavant (11/12/25)
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  • Supervisor, Healthcare Services Operations Support

    Molina Healthcare (Jacksonville, FL)
    …Required Qualifications* At least 5 years of operations or administrative experience in health care , preferably within a managed care setting, or equivalent ... and supervises a team supporting non-clinical healthcare services activities for care management, care review, utilization management, transitions of … more
    Molina Healthcare (11/09/25)
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  • Referrals Team Supervisor - Broward County

    ChenMed (North Lauderdale, FL)
    …and making decision based of the data + Experience working in Medicare managed care environment **PAY RANGE:** $48,418 - $69,168 Salary **EMPLOYEE BENEFITS** ... your kindness and joy? We're different than most primary care providers. We're rapidly expanding and we need great...all times. + Manages, coaches and provides training to Care Coordinators; ensures they are following company processes. Training… more
    ChenMed (10/28/25)
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  • Health Individual Marketplace Strategies Principal…

    Prime Therapeutics (Tallahassee, FL)
    Care Exchange business or other Government Programs lines of business + Managed care experience + Experience in Project Management/Ownership + Experience with ... purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven...the Individual and Small Group Exchanges under the Affordable Care Act. This position ensures quality and compliance standards… more
    Prime Therapeutics (12/10/25)
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  • Senior Medical Director

    Molina Healthcare (Miami, FL)
    …experience, and at least 2 years as a medical director in managed care setting supporting utilization management/quality management initiatives, or equivalent ... to members - ensuring members receive the most appropriate care in the most effective setting. Contributes to overarching...to overarching strategy to provide quality and cost-effective member care . Essential Job Duties * Leads a team of… more
    Molina Healthcare (12/07/25)
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  • Case Manager RN

    CVS Health (Tallahassee, FL)
    …RN License + Certified Case Manager (CCM) + Case Management experience + Managed Care experience + Telephonic case management and/or telephonic customer service ... ourselves with dedicated colleagues who are passionate about transforming health care . As the nation's leading health solutions company, we reach millions… more
    CVS Health (12/06/25)
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  • Provider Contract Data Consultant Sr

    Elevance Health (Tampa, FL)
    …or related field and a minimum of 7 years experience in broad-based analytical, managed care payor or provider environment as well as in depth experience ... Provides the highest level of analytical support to the Cost of Care and/or Provider Contracting organizations. Focuses efforts on lowering claims costs, improving… more
    Elevance Health (11/21/25)
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  • Medical Insurance Verifier

    HCA Healthcare (Sarasota, FL)
    …+ You are responsible for identifying patient accounts based on PPO, HMO, or other Managed Care Organizations + You will contact patients and provide updates on ... to caring for patients with purpose and integrity. We care like family! Jump-start your career as a Medical...and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. +… more
    HCA Healthcare (09/25/25)
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