- MyFlorida (Tallahassee, FL)
- …and planning entity. The Agency is responsible for administering the Florida Medicaid program, the licensure and regulation of nearly 50,000 health care facilities, ... ecosystem, and increasing insight in the cost of health care services. The Medicaid program provides low-income families and individuals with access to health care.… more
- MyFlorida (Spring Hill, FL)
- …number, Medicaid numbers, etc. Verifies Medicaid , Medicare, Health Management Organization (HMO), Private insurance and financial eligibility in the ... number, Medicaid numbers, etc. Verifies Medicaid , Medicare, Health Management Organization (HMO), Private insurance and financial eligibility in the… more
- MyFlorida (Bunnell, FL)
- …Fiscal Department at the Flagler County Health Department. This position determines eligibility for a variety of State and Federal programs. Fiscal Assistant I, ... require independent decision making and judgment. Duties involve processing Medicaid HMO's, Medicare and third party/commercial insurance claims. Responsible for… more
- MyFlorida (Tallahassee, FL)
- …Subpart F. The position is responsible for handling all aspects of assigned Medicaid fair hearing proceedings including case management , conducting the fair ... responsibility of the Hearing Officer position is to conduct fair hearings for Medicaid programs administered by the Agency for Health Care Administration under the… more
- MyFlorida (Miami, FL)
- …Position Summary:This position is in the Office of the Attorney General within the Medicaid Fraud Control Unit in Miami or West Palm Beach, Florida, and involves ... and judgment when applying the rules, regulations and laws of the Medicaid unit, both Federal and State. Pay:$60,935.16 Annually. Qualifications: + Six (6)… more
- NHS Management, LLC (Daytona Beach, FL)
- …assigned business and financial functions within the parameters established by NHS Management , LLC guidelines, state and federal regulations, and as needed to ... office related tasks, including but not limited to: + Medicaid , Medicare and/or secondary billing + Assist with evaluation...timely submission to prevent delays in the attainment of eligibility and payment. Process to include: + Meeting with… more
- CVS Health (Tallahassee, FL)
- …professionalism, and self-direction. + Demonstrate a willingness to learn about care management within Medicare and Medicaid managed care. + Familiarity with ... and every day. **Program Summary** Join our Aetna care management team as we lead the way in providing...(DSNP) members, who are enrolled in both Medicare and Medicaid . As a member of the care team, you… more
- Actalent (Sunrise, FL)
- …review + Utilization management + InterQual + Milliman Commercial Guidelines + Medicaid + Medical management + Medicare + Managed care + Patient care ... Actalent is hiring a Utilization Management Nurse! Job Description The Utilization Management...including InterQual and Milliman Criteria. + Knowledge of Florida Medicaid Program and CMS Guidelines. + Proficient in word… more
- Prime Therapeutics (Tallahassee, FL)
- …and drives every decision we make. **Job Posting Title** Medication Therapy Management (MTM) Technician **Job Description** The MTM Technician is responsible for ... of business to support the Centers for Medicare & Medicaid Services (CMS) Star and HEDIS quality measure programs,...measure programs, including but not limited to: Medication Therapy Management (MTM), Adherence, and Statin use in Persons with… more
- CVS Health (Tallahassee, FL)
- …lost funds, and to comply with state regulations mandating fraud plans and reporting; Medicaid experience is preferred. Leads a team in the planning and execution of ... + A minimum 3 years of experience in a Healthcare Program Integrity, Medicaid Special Investigation or Medicaid / Medicare / Commercial Compliance role… more