- Prime Therapeutics (Tallahassee, FL)
- …This role is dedicated to the government program compliance in the Medicare , Medicaid, and the Affordable Care Act (ACA) spaces. **Responsibilities** + Executes ... of interest or other cyclical compliance processes, or implementing a regular review cadence for standard operating procedures (SOP) and policies + Research and… more
- Evolent (Tallahassee, FL)
- …provides clinical rationale for standard and expedited appeals. . Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD ... review process to reflect appropriate utilization and compliance with...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Evolent (Tallahassee, FL)
- …available, within the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance… more
- Evolent (Tallahassee, FL)
- …provides clinical rationale for standard and expedited appeals. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD ... review process to reflect appropriate utilization and compliance with...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Evolent (Tallahassee, FL)
- …available, within the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality Assurance… more
- Prime Therapeutics (Tallahassee, FL)
- …benefit design and pricing support for all Prime's lines of business (commercial, Medicare and Medicaid). This role will also provide actuarial support in complex ... support, and maintain financial and complex actuarial models + Lead, perform, and review data analyses, reporting, and projections + Lead, perform, and review … more
- Prime Therapeutics (Tallahassee, FL)
- …design and pricing support for all Prime's lines of business (commercial, Medicare and Medicaid). **Responsibilities** + Build, support, and maintain financial and ... actuarial models + Perform and review data analyses, reporting, and projections...healthcare organization or PBM + Previous experience pricing Commercial, Medicare or Medicaid lines of businesses + 1 year… more
- University of Miami (Miami Beach, FL)
- …staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The ... HIPAA Notice of Privacy, No Surprise Billing, Good Faith Estimate, Off Campus Medicare Co-insurance and Advance Beneficiary Notices, and Medicare Secondary Payer… more
- CenterWell (Jacksonville, FL)
- …quality of care, clinical outcomes, and avoidable utilization + Periodically review clinician charts to identify opportunities in care, ensuring clinical assessments ... indicators (KPIs), such patient experience via Net Promoter Score (NPS) and Medicare clinical quality via HEDIS, meeting local and organizational goals + Personally… more
- Prime Therapeutics (Tallahassee, FL)
- …Subject Matter Expertise in their areas of focus (Affordable Care Act, Medicare , Medicaid, Corporate Compliance, Compliance Assessment or Services etc.) + Develop ... procedures (Standard Operating Procedures, Desk Top Procedures, etc.) and review applicable operations teams' documentation; develop regulatory monitoring and… more