- Humana (Tallahassee, FL)
- …Professional Business Intelligence Engineer** is an experienced individual with broad Medicaid Managed Care expertise, deep analytics expertise, and a proven ... is to advance personalized solutions that foster whole person care to engage and empower our members in their...reporting and data analysis + 3+ years of health care experience for Medicare and/or Medicaid populations + Proven… more
- America's Best (Pinellas Park, FL)
- …phone calls in accordance with National Vision protocol. + Processes and understands managed care plans while obtaining document information from the insurance ... parts of the optical equation - eyewear and eye care - into one excellent experience at a single...their best. We help people by making quality eye care and eyewear more affordable and accessible. As the… more
- Humana (Tallahassee, FL)
- …Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization. **Additional Information** **Work Schedule:** + ... policies and procedures ensuring best and most appropriate treatment, care or services for members. UM Administration Coordinator 2...and wellness through plans with benefits and services they care about. As a wholly owned subsidiary of Humana,… more
- Elevance Health (Miami, FL)
- …experience and requires a minimum of 2 years clinical, utilization review, or managed care experience; or any combination of education and experience, which ... not be receiving appropriate type, level, or quality of care , eg, if services are not in line with...recommendations on alternate types, places, or levels of appropriate care by leveraging critical thinking skills and nursing judgment… more
- CVS Health (Plantation, FL)
- …in health insurance, healthcare services, or client/account management. + Familiarity with managed care processes, healthcare sales, or pharmacy benefits. + ... ourselves with dedicated colleagues who are passionate about transforming health care . As the nation's leading health solutions company, we reach millions… more
- Ascension Health (Jacksonville, FL)
- …Review and Credentialing + Growth and Strategic Planning + Population Health + Managed Care + Oversees the development and continuous improvement of services, ... + Responsible for monitoring, measurement and quality improvement of clinical care utilizing evidence-based best practices to support, promote and oversee patient… more
- Humana (Tallahassee, FL)
- …+ Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization + Proficient utilizing electronic medical record ... support for the policies and procedures ensuring best and most appropriate treatment, care or services for members. The Home Solutions UM Team is hiring for… more
- Humana (Niceville, FL)
- …Walton, Bay, Holmes, Washington, Jackson, and Calhoun + 1 - 5 years of Health care or managed care with Provider Contracting, Network Management or Provider ... + Proficiency in analyzing and interpreting financial trends for health care costs, administrative expenses and quality/bonus performance + Comprehensive knowledge… more
- Actalent (Sunrise, FL)
- …+ Interqual + Milliman Commercial Guidelines + Medicaid + Medical management + Medicare + Managed care + Patient care + Medical record Additional Skills & ... work processes and policy guidelines. + Promote safe and appropriate coordination of care and optimal utilization of resources. + Identify and participate in the… more
- Prime Therapeutics (Tallahassee, FL)
- …a regulatory or compliance role, with a minimum of 3 years of experience working with managed care companies or other health care clients Must be eligible to ... for proactively addressing the constant changes in today's health care industry. Our employees are involved, empowered, and rewarded...and work collaboratively to provide the highest quality of care and service to our members. If you are… more