- Prime Therapeutics (Tallahassee, FL)
- …drives every decision we make. **Job Posting Title** VP Government Programs - Medicare & Managed Medicaid (REMOTE) **Job Description** The Vice President ... Government Programs - Medicare & Managed Medicaid is responsible for the development, administration, and execution of strategic plans that advance Prime's… more
- Humana (Tallahassee, FL)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... a part of our caring community and help us put health first** The Medicaid (PPS) Provider Hospital Reimbursement Analyst also known as a Senior Business Intelligence… more
- Humana (Fort Lauderdale, FL)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... caring community and help us put health first** The Vice President, Medicaid Clinical Economics & Quality provides strategic and operational leadership for clinical… more
- Humana (Tallahassee, FL)
- …**Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other ... Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid , or Commercial health insurance. +… more
- Humana (South Miami, FL)
- …Advantage health plans in Florida over 23 years. CarePlus strives to help people with Medicare , or both Medicare and Medicaid , achieve their best possible ... are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. … more
- Humana (Tallahassee, FL)
- …efforts are leading to a better quality of life for people with Medicare , Medicaid , families, individuals, military service personnel, and communities at large. ... a part of our caring community and help us put health first** The Sr. Medicare (PPS) Provider Hospital Reimbursement Analyst will be an integral part of the Pricer… more
- Molina Healthcare (Tampa, FL)
- …with clinical leadership and quality improvement teams. * Facilitates conformance to Medicare , Medicaid , NCQA and other regulatory requirements. * Reviews ... quality referred issues, focused reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * Attends or chairs committees as required such as credentialing,… more
- CenterWell (Tallahassee, FL)
- …+ Collaborate with market partners and HPS team members to prioritize project requests + Develop project plans, timelines and update cadence for all projects + ... **Become a part of our caring community and help us put health first** The Project Management Lead manages all aspects of a project, from start to finish, so that it is completed on time and within budget. The Project Management Lead works on problems of… more
- Fresenius Medical Center (Jacksonville, FL)
- …insurance options: + Educates on the availability of alternative insurance options (ie, Medicare , Medicaid , Medicare Supplement, State Renal programs and ... + Discusses insurance options when insurance contracts are terminated. Responsibilities involving Medicare and Medicaid include but are not limited to: +… more
- Humana (Tallahassee, FL)
- …for the development, implementation and management oversight of the company's Medicare / Medicaid Stars Program. The Senior Stars Improvement, Clinical ... years of prior HEDIS, STARS and/or quality improvement experience in Medicaid or Medicare ( Medicaid quality improvement a plus). + Proficient/ intermediate… more