- Humana (Tallahassee, FL)
- …data driven methods to develop and influence formulary strategies for Humana's Medicare line of business. + Utilizes broad understanding of pharmacy, managed care, ... pharmacy related field + Experience in Formulary strategy/development and CMS Part D guidance + Experience in analysis and...with staff in different positions and all levels of management positions. + Ability to prioritize, organizes, and executes… more
- Molina Healthcare (FL)
- …Action Items (SAIs) including assisting and executing projects and tasks to ensure CMS and State regulatory requirements are met for pre-pay edits, post payment ... and experience. + At least 3 years of Experience with Medicaid and/or Medicare . + Proven experience owning operational projects from concept to execution, especially… more
- Humana (Tallahassee, FL)
- …by reading and interpreting claims + Exceptional understanding of Centers for Medicare & Medicaid Services ( CMS ) guidelines, state Medicaid guidelines, correct ... first** The Senior Payment Integrity Coding Professional within Code Edit Vendor Management (CEVM) contributes to overall cost reduction by utilizing code editing… more
- Molina Healthcare (FL)
- …contracted provider network. They are responsible for network management including provider education, communication, satisfaction, issue intake, access/availability ... staff to determine; for example, non-compliance with Molina policies/procedures or CMS guidelines/regulations, or to assess the non-clinical quality of customer… more
- Prime Therapeutics (Tallahassee, FL)
- …benefits consultants, key state leaders, industry trade associations, and Centers for Medicare and Medicaid Services ( CMS ); establish an effective communication ... teams, ensuring adequate representation for market-specific client needs; align account management activities across all lines of business and develop methodologies,… more
- MyFlorida (Delray Beach, FL)
- …weekends and holidays. This position requires successful completion of all Center for Medicare Services ( CMS ) Quality, Safety & Education Portal (QSEP) training ... PROTECTION SPECIALIST Date: Aug 4, 2025 The State Personnel System is an E-Verify employer. For more information click...of other types of licensed providers, as assigned by management . The incumbent must be proficient with computer equipment… more
- Molina Healthcare (Tampa, FL)
- …Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + Identifies and reports ... be required. + Serves as a clinical resource for Utilization Management , Chief Medical Officer, Physicians, and Member/Provider Inquiries/Appeals. + Provides… more
- Healthfirst (FL)
- …with internal teams (eg, sales, customer service, compliance) to ensure seamless management of members. + Monitor ,report, and deliver updates on memberships, data ... Billing activities are managed in compliance with State and CMS guidelines and to ensure member satisfaction + Lead...Working knowledge of how data processes through systems and system integrations work to understand and plan for addressing… more
- University of Miami (Miami, FL)
- …Ensure compliance with healthcare regulations including those set by the Centers for Medicare and Medicaid Services ( CMS ), Joint Commission and other regulatory ... the facility, ensuring the delivery of high-quality patient care, efficient management of resources and compliance with healthcare regulations. This leadership role… more
- HCA Healthcare (Gainesville, FL)
- …daily ancillary charge report to identify any potential charging issue related to system failures, system updates or other. Reviews denial trends for ... deactivation, or modification). + Review HCA regulatory communications, applicable CMS transmittals, and Local Coverage Determinations (LCDs), assess their impact… more