- Humana (Miramar, FL)
- …company records and those maintained by the Centers for Medicare and Medicaid Services. This role encompasses a range of moderately complex administrative, ... effectively managing multiple priorities. + Familiarity with Centers for Medicare and Medicaid Services (CMS) regulations is preferred. + Must be passionate about… more
- Humana (Tallahassee, FL)
- …ensure successful submission and reconciliation of encounter submissions to Medicaid /Medicare. Ensures encounter submissions meet or exceed all compliance standards ... and develops tools to enhance the encounter acceptance rate by Medicaid /Medicare. Looks for long term improvements of encounter submission processes. Understands… more
- Highmark Health (Tallahassee, FL)
- …goals including but not limited to Government Markets (STARS, ACA, CHIP, Medicaid DE) and Enterprise Quality, Safety, and Values (Health Outcomes Measures). Provide ... share models and will be implemented for the Organization's Medicare Advantage, Medicaid , ACA, and commercial populations with the goal of maximizing quality while… more
- Humana (Tallahassee, FL)
- …other vendors. + Document all calls and requests. + Search for Medicare and Medicaid Guidelines. + Process all incoming fax/emails request for services the same day. ... years. CarePlus strives to help people with Medicare, or both Medicare and Medicaid , achieve their best possible health and wellness through plans with benefits and… more
- Molina Healthcare (Tampa, FL)
- …complaints. Works with enrollees and providers to facilitate the provision of Medicaid benefits and ensure enrollee's rights are upheld. Helps enrollees understand ... and members regarding community agencies, services and referrals for special needs, Medicaid in general, or other related needs. * Participates in the Statewide… more
- Prime Therapeutics (Tallahassee, FL)
- …pharmaceutical manufacturers, with specific emphasis on Medicare Part D and Managed Medicaid . The Sr Director, Pharm Trade Relations leads a team of directors ... Trade formulary strategies for Commercial, Exchange, Medicare Part D and/or Medicaid template formularies, including items such as manufacturer and GPO negotiation,… more
- Molina Healthcare (FL)
- …and administration of contracts with State and/or Federal governments for Medicaid , Medicare, Marketplace, and other government-sponsored programs to provide health ... Experience** * 2+ years experience in a managed care environment, preferably in Medicaid environment. * Knowledge of state Medicaid Policies and Programs.… more
- Humana (Tallahassee, FL)
- …of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ ... in a medical management review organization, such as Medicare Advantage, managed Medicaid , or Commercial health insurance. + Experience with national guidelines such… more
- Humana (Tallahassee, FL)
- …of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ ... in a medical management review organization, such as Medicare Advantage, managed Medicaid , or Commercial health insurance. + Experience with national guidelines such… more
- Humana (Orlando, FL)
- …dynamic professionals, we hope you will apply! The Care Coach 1 + Visit Medicaid members in their homes, Assisted Living Facilities, and/or Long Term Care Facilities ... 4 years of relevant experience + Prior experience with Medicare & Medicaid recipients + Minimum 2 years case management experience + Bilingual (English/Spanish)… more