- Molina Healthcare (Tampa, FL)
- …integrity issues, and process gaps. + Applies understanding of healthcare regulations, managed care claims workflows, and provider reimbursement models to shape ... years of experience as a Business Analyst or Program Manager in a Managed Care Organization (MCO) or health plan setting, including experience in Medicaid and/or… more
- Molina Healthcare (St. Petersburg, FL)
- …integrity issues, and process gaps. + Applies understanding of healthcare regulations, managed care claims workflows, and provider reimbursement models to shape ... years of experience as a Business Analyst or Program Manager in a Managed Care Organization (MCO) or health plan setting, or equivalent combination of relevant… more
- Molina Healthcare (FL)
- …integrity issues, and process gaps. + Apply understanding of healthcare regulations, managed care claims workflows, and provider reimbursement models to shape ... years of experience as a Business Analyst or Program Manager in a Managed Care Organization (MCO) or health plan setting, or equivalent combination of relevant… more
- BD (Becton, Dickinson and Company) (Stuart, FL)
- …and is responsible for the establishment, development and execution of the payor, managed care , and payer contracting medical policy initiatives in collaboration ... with payers.. + Negotiates and manages, either directly or indirectly, with managed care providers to ensure the best possible reimbursement for products and… more
- Molina Healthcare (St. Petersburg, FL)
- …and strong system knowledge of QNXT and other state specific applications concerning Managed Care Enrollment. + Responsible for ensuring timely reconciliation of ... education and experience **Required Experience** 5-7 years Enrollment-related experience in Managed care or Medicare setting **Preferred Education** Graduate… more
- Highmark Health (Tallahassee, FL)
- …federal and state rules as well as a solid working knowledge of managed care operations, compliance program structures, information security and audit ... in leading interdepartmental and cross-functional strategy development. + Experience with managed care , Medicare and federal and/or state regulations, quality… more
- Molina Healthcare (Miami, FL)
- …or related **REQUIRED EXPERIENCE:** 1-3 years in case management, disease management, managed care or medical or behavioral health settings. **REQUIRED LICENSE, ... experience. **PREFERRED EXPERIENCE:** 3-5 years in case management, disease management, managed care or medical or behavioral health settings. **PREFERRED… more
- HCA Healthcare (Port St. Lucie, 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
- Elevance Health (Tampa, FL)
- …acute care setting. + Minimum 2 years "telephonic" Case Management experience with a Managed Care Company. + Managed Care experience. For candidates ... be required.** The **Telephonic Nurse Case Manager II** is responsible for performing care management within the scope of licensure for members with complex and… more
- Elevance Health (Tampa, FL)
- …Critical Care preferred. + Prior "telephonic" Case Management experience with a Managed Care Company preferred + Certification as a Case Manager. + Ability ... review and respond to emails/instant messages in a timely fashion. + Managed Care (Home Heath, Insurance, Inpatient) experience. Please be advised that Elevance… more