- Humana (Tallahassee, FL)
- …while providing clinical support for internal stakeholders. Utilizes broad understanding of managed care and PBM knowledge to develop, and/or implement ... - Medicaid health plan. The individual leverages a broad understanding of managed care and pharmacy benefit management (PBM) to develop and implement strategies… more
- MyFlorida (Tallahassee, FL)
- …1115 waivers and home and community-based waivers), administrative rules, coverage policies, managed care plan contracts, bill analyses, drug utilization review ... development of policy language for: Medicaid contracts and amendments, Medicaid managed care report guides, contract interpretations, policy transmittals, and… more
- Elevance Health (Miami, FL)
- …the applicable medical policy and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers, ... and ability to interpret and apply member contracts, member benefits, and managed care products strongly preferred for associates performing medical management.… more
- CenterWell (Tallahassee, FL)
- …services such as inpatient rehabilitation. **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed ... caring community and help us put health first** The Medical Director, Primary Care relies on medical background and reviews health claims. The Medical Director,… more
- HCA Healthcare (Bradenton, FL)
- …contracting issues. + Provides medical consultation on contracting, pricing, and analysis of managed care issues. Offers clinical support for appeals and denials ... regarding delegated utilization management and disease management operations under managed care contracts. Meets all regulatory/contractual/accreditation requirements… more
- Molina Healthcare (Tampa, FL)
- …guidelines. + Experience in Utilization/Quality Program management + HMO/ Managed care experience **PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:** ... and action plan, which includes strategies that ensure a high quality of patient care , ensuring that patients receive the most appropriate care at the most… more
- CenterWell (New Port Richey, FL)
- …contributing to an organization focused on continuously improving consumer experience + Managed care experience **Preferred Qualifications** + Basic knowledge ... member of an interdisciplinary team + Solid understanding of medical care delivery, managed care financial arrangements and reimbursement + Bachelor's… more
- Abbott (Gainesville, FL)
- …meeting or exceeding sales quotas/objectives for ADC Products. Collaborate with various channels, Managed Care and Retail and Point of Care representatives. ... sales quotas/objectives for ADC Products. + Collaborating with various channels, Managed Care , Retail, and Point of Care representatives. + Establishing… more
- CenterWell (Tallahassee, FL)
- …required. + Familiar with CAQH + Bilingual; English & Spanish + Experience in managed care or health care administration desired **Additional Information** + ... regarding own work approach/priorities, and follows direction. Work is managed and often guided by precedent and/or documented procedures/regulations/professional… more
- Centers Plan for Healthy Living (Margate, FL)
- …proficiency + Strong multi-tasking abilities Preferred: + Experience working within a managed care environment Specific Technical Skills Preferred: + Computer ... a multidisciplinary care team to assist with the care of members enrolled in our Managed Long Term Care program and facilitate authorization requests… more