• Medical Director - National Medicare

    Humana (Tallahassee, FL)
    …internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements and will understand ... radiology, and genetics.** + Knowledge of the managed care industry including Medicare Advantage and Managed Medicaid. + Utilization management experience in… more
    Humana (07/21/25)
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  • Medicare Sales Field Agent - CarePlus…

    Humana (Palm Bay, FL)
    …Health Plans is a recognized leader in healthcare delivery that has been offering Medicare Advantage health plans in Florida over 23 years. CarePlus strives to ... us put health first** Are you passionate about the Medicare population, looking for an opportunity to work in...applicants selected for leader review may be asked to provide their social security number, if it is not… more
    Humana (07/30/25)
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  • Medicare Risk Adjustment Advanced Analytics…

    Elevance Health (Tampa, FL)
    …and prospective risk adjustment initiatives, operational effectiveness and efficiencies, provider performance , and population health. **How You Will ... not limited to: + Analyzes and develops SAS and SQL programming to support Medicare Advantage risk adjustment initiatives. + Performs data mining and data-driven… more
    Elevance Health (07/29/25)
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  • Director, Provider Contracting

    Humana (Tallahassee, FL)
    …productive. Our wholly owned affiliate, CarePlus, operates in 18 Florida counties, offering Medicare Advantage HMO plans that have been awarded 5-Star ratings by ... Vice President. **Key Responsibilities** + Initiate, negotiate, and execute value-based Medicare Advantage contracts and agreements with physicians and other… more
    Humana (07/21/25)
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  • Provider Inquiry Manager

    DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
    …by management Qualifications: + Minimum of 10 years of healthcare operations or Medicare Advantage experience; strong knowledge of Medicare Advantage ... The Provider Inquiry Manager provides leadership and oversight of...dispute manual, SOP, workflows and policies and procedures + Provide on-going training and coaching to staff + Develop… more
    DOCTORS HEALTHCARE PLANS, INC. (07/26/25)
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  • Representative, Provider Relations HP

    Molina Healthcare (FL)
    …member satisfaction - CAHPS, regulatory-related, Molina Quality programs, and taking advantage of electronic solutions (EDI, EFT, EMR, Provider Portal, ... a managed care setting. * Working familiarity with various managed healthcare provider compensation methodologies, primarily across Medicaid and Medicare lines… more
    Molina Healthcare (08/02/25)
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  • Customer Service Performance Manager

    WTW (Tampa, FL)
    …a leading direct-to-consumer insurance services business, specializing in the distribution of Medicare Advantage , Medicare Supplement and Life & Supplemental ... ensure adherence to compliance and quality assurance standards. + Provide coaching, mentorship, and performance feedback to...in telemarketing or call center settings. + Knowledge of Medicare Advantage , Medicare Supplement, Life… more
    WTW (07/08/25)
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  • Actuary, Risk and Compliance

    Humana (Tallahassee, FL)
    …and allows you to see the overall end to end bid process at a leading Medicare Advantage organization. This is a great role for a collaborative individual who is ... may include monitoring and researching laws and regulations applicable to Medicare Advantage and actuarial science. Advises certifying actuaries, executives… more
    Humana (07/30/25)
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  • Delaware Valley ACO Fellowship

    Humana (Tallahassee, FL)
    …Medicaid Services' Medicare Shared Savings Program (MSSP), plus other commercial and Medicare Advantage value based programs. DVACO is a joint venture among ... grouping, with more than 2,000 physicians and approximately 70,000 Medicare fee-for-service beneficiaries. Additionally, DVACO currently holds performance -based… more
    Humana (07/30/25)
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  • Medical Director- South Central

    Humana (Tallahassee, FL)
    …internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and Medicare Advantage requirements, and will understand ... **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage , Managed Medicaid and/or Commercial products, or other… more
    Humana (07/11/25)
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