- Humana (Tallahassee, FL)
- …and other sources of expertise. The Behavioral Health Medical Directors will learn Medicare , Medicare Advantage and Medicaid requirements, and will ... rehabilitation **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage and Managed Medicaid products, or other Medical… more
- Humana (Miami, FL)
- …productive. Our wholly-owned affiliate, CarePlus, operates in 21 Florida counties, offering Medicare Advantage HMO plans that have been awarded 5-Star ratings ... office in Doral. **Key Responsibilities** + Initiate, negotiate, and execute value-based Medicare Advantage contracts and agreements with physicians and other… more
- Humana (Tallahassee, 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 ... part of our caring community and help us put health first** The Provider Contracting Executive initiates, negotiates, and executes physician, hospital, and/or other … more
- 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
- Humana (Tallahassee, FL)
- …Policies and Procedures, and clinical literature as appropriate. Medical Directors will learn Medicare Part D and Medicare Advantage requirements and will ... Director will collaborate with clinicians and support staff to provide Humana members with optimal value based care in...experience in a medical management review organization such as Medicare Advantage , managed Medicaid, or Commercial health… more
- 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 (Tallahassee, FL)
- …growth strategy, leading the development of the annual Medicare Advantage strategic plan, monitoring segment-wide operational performance , and refreshing the ... Insurance segment's highest priority projects and initiatives, with an emphasis on Medicare Advantage strategy development. As a Senior Strategy Advancement… more
- 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
- Highmark Health (Tallahassee, FL)
- …gain share and risk share models and will be implemented for the Organization's Medicare Advantage , Medicaid, ACA, and commercial populations with the goal of ... DE) and Enterprise Quality, Safety, and Values (Health Outcomes Measures). Provide actionable opportunities in provider transformation aimed at high-quality,… more
- Humana (Tallahassee, FL)
- …internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements, and will understand ... help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home health, SNF, DME, dual Medicare… more
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