- Humana (Tallahassee, FL)
- …are leading to a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at large. **Equal ... Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information,… more
- Molina Healthcare (Tampa, FL)
- …with business and other IT teams to deliver successful and certifiable Medicaid Management Information Systems solutions. * Works closely with EPMO, business ... stakeholders to manage priorities deliveries and expectations. **Job Qualifications** **Required Education** Graduate Degree or equivalent combination of education and experience **Required Experience** 7-9 years Application Design, Development Experience and,… more
- Prime Therapeutics (Tallahassee, FL)
- …management. Enforces teamwork across all internal departments, as well as with Medicaid Clients, and an in-depth understanding of all rebate programs, trends, and ... state laws and standards of practice which govern the Medicaid Drug Rebate Program. + Ensures compliance with each...auditors for yearly SOC-1 audit. + Works directly with Director to fulfill OIG and CMS audit requests. +… more
- Intermountain Health (Tallahassee, FL)
- …and other administrative functions for the Medical Staff, Medical Director , Administration, and Allied Health Professionals. **Essential Functions** + Participates ... payer re-credentialing requests and demographic/roster requests. + Completes out-of-State Medicaid individual and facility enrollments timely and accurately for… more
- MyFlorida (Tallahassee, FL)
- …of Florida, including in areas of criminal appeals, civil litigation, consumer protection, Medicaid fraud, and victims and civil rights. We invite you to visit our ... Unfair Trade Practices Act. + Provides feedback and recommendations to CS Director , and supervisors, and fosters open communication between all management team. +… more
- Actalent (Sunrise, FL)
- …appropriate service utilization. Working under the general supervision of the Director and/or Manager/Supervisor of Medical Management, and in collaboration with an ... utilizing standardized Review Criteria. + Coordinate with the Medical Director /Physicians for requests outside standard Review Criteria. + Maintain compliance… more
- Humana (Tallahassee, FL)
- …of this evolution is Humana's Insurance Segment, which provides Medicare Advantage, Medicaid , and other health plans to millions. By integrating insurance with care ... plays a pivotal role in defining the future of Humana's Medicare and Medicaid businesses, which generate the majority of the company's total revenue and earnings.… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …necessity for the requested level of care/patient status to the Medical Director . + Proactively identifies and resolves delays and obstacles for safe discharge. ... of resources, avoidable days/denials. Works in collaboration with Appeals Management/Medical Director in the appeals process. + Responsible for the appropriate use… more
- Actalent (Sunrise, FL)
- …using standardized Review Criteria. + Coordinate with the Medical Director /Physicians for requests outside standard Review Criteria. + Maintain compliance ... of assigned caseload. + Serve as a liaison between the Medical Director , physicians, and office staff to resolve authorization issues. + Communicate denial… more
- Humana (Tallahassee, FL)
- …mitigate risks. The Senior Clinical Compliance Professional will support the Director of Compliance, by ensuring compliance with governmental requirements for ... revenue cycle management (related to billing, coding, collections for Medicare and Medicaid claims) + Experience with Auditing and monitoring of healthcare records +… more