- AdventHealth (Maitland, FL)
- …Provides guidance and direction to PFS, Central Denials, Patient Access and Managed Care staff regarding contract terms and policies including; governmental ... key contract data elements which are populated into the Managed Care database including addition of new...contract language, including rate updates, to the Information Systems Coordinator for scanning with appropriate filing form for the… more
- MyFlorida (Jacksonville, FL)
- …. Requisition No: 865553 Agency: Department of Health Working Title: Care Coordinator Pay Plan : Career Service Position ... Care Coordinator Date: Nov 20, 2025 The...DCF, Care Team meetings, (ICT calls with managed care organizations MCO), and other staffing. Documents… more
- Centers Plan for Healthy Living (Margate, FL)
- …guidance and plans they need for healthy living. JOB SUMMARY: The Utilization Management Care Coordinator works within a multidisciplinary care team to ... in completing authorization updates as needed based on the care plan of the member + Coordinates...Strong multi-tasking abilities Preferred: + Experience working within a managed care environment Specific Technical Skills Preferred:… more
- University of Miami (Miami, FL)
- …reports to the Director of the Division of CME and provides support for courses managed by the Division. The Senior Program Coordinator works closely with CME ... has an exciting opportunity for a full-time Sr. Program Coordinator to work in Miami, FL. The Sr. Program...Creates monthly budget reports to ensure operations are within plan . + Assists with database maintenance and enrollment management.… more
- Humana (Tallahassee, FL)
- …+ Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization + Knowledge of Medical Terminology and/or ICD-10 ... codes + Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization + Bilingual (English & Spanish) fluent in… more
- Humana (Tallahassee, FL)
- …+ Experience with Utilization Review and/or Prior Authorization, preferably within a managed care organization + Proficient utilizing electronic medical record ... caring community and help us put health first** The UM Administration Coordinator contributes to administration of utilization management. The UM Administration … more
- Highmark Health (Tallahassee, FL)
- …degree + Pharmacy technician certification certificate + Experience working in a managed care medication formulary management environment + Working knowledge of ... reviewer in monitoring and ensuring adherence to the health plan 's state and federal multiple drug benefit design offerings....to ensure that the needs of the provider and plan member are addressed in a courteous, helpful and… more
- CVS Health (Tallahassee, FL)
- …and stable health conditions. The CMS collaborates closely with the Registered Nurse Care Manager, Care Coordinator , Social Worker, and other ... Summary** As an essential member of our Special Needs Plan (SNP) care team, the telephonic ...of care management within Medicare and Medicaid managed care . + **Community Resources:** Familiarity with… more
- Option Care Health (Tallahassee, FL)
- …IG to include clinical, market, and payer dynamics + Knowledge of reimbursement, managed care , and marketing **Basic Qualifications** + Proven record of ... clinicians as well as medical office staff (ie biologics coordinator ) to appropriately promote Option Care Health...Maintain a call average as outlined in the sales plan , defined as face-to-face interactions with healthcare providers, focusing… more
- CVS Health (Sun City Center, FL)
- …using care management tools and information/data review. Coordinates and implements assigned care plan activities and monitors care plan progress. ... changing environment - Effective communication skills, both verbal and written - Managed Care experience - Computer proficiency in Microsoft Word, Excel,… more