- Datavant (Tallahassee, FL)
- …work environment. + Keep up to date with current coding policies for ICD-10, Medicare Advantage, HHS (ACA), and other markets. + Provide guidance and make strategic ... or inpatient setting. + Current CCS, CRC, or CPC required. + Previous Medicare Advantage Risk Adjustment, CDI, Medicaid, Commercial RA, and HEDIS experience. +… more
- Highmark Health (Tallahassee, FL)
- …drug benefit strategies, drug formularies, and programs specifically for the Medicare Advantage (MA) market. The incumbent will contribute to recommendations for ... for timely review with the Director, Clinical Pharmacy. + Participate in Medicare Stars performance measures to drive contribution to excellence (5 Stars). +… more
- Humana (Tallahassee, FL)
- …of our caring community and help us put health first** We are seeking a Senior Accreditation Professional who will work in a team environment on Humana's health plan ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- Prime Therapeutics (Tallahassee, FL)
- …decision we make. **Job Posting Title** Clinical Pharmacist (Algo), Professional- Senior - REMOTE **Job Description** Maintains the inventory of clinical algorithms. ... based upon relevant source data (eg clinical criteria, client criteria, Medicare LCD). Provides support for clinical client inquiries and internal partners.… more
- Humana (Tallahassee, FL)
- …shaping the future of healthcare through AI excellence. We are seeking a Senior Data Scientist to develop reliable, interpretable, and steerable AI systems. Our goal ... efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service personnel, and communities at large. … more
- CVS Health (Tallahassee, FL)
- …role? Join Aetna/CVS Health, a Fortune 4 company, as the Network Management Senior Manager. In this role, you will manage negotiations, conduct high-level reviews ... and developing yourself and others) skills **Required Qualifications** * Commercial, Medicare , and/or Medicaid knowledge * 5+ years related experience, proven and… more
- Ascension Health (Pensacola, FL)
- …substance oversight, and billing including, Long Term Care (LTC) billing and Medicare D claim adjudication. + Serve as a resource for automation technology, ... and 2,600 sites of care, including more than 140 hospitals and 40 senior living communities in 19 states. Our Mission, Vision and Values encompass everything… more
- Akumin (Tampa, FL)
- Role is based in Florida. The ** Senior ** **Director of Operations** manages the daily operations, and planning the use of materials and human resources. Provide ... adaptability and ability to manage change. + Knowledge of Workers' Compensation, Medicare and/or clinical standards of practice, preferred. + Prior experience in an… more
- CVS Health (Tallahassee, FL)
- …of 3 years managing/leading a team. + Experience working in Medicare , Medicaid, or Commercial Health Insurance. **Preferred Qualifications** + Experience working ... in credentialing operations. + Strong written and verbal communication. **Education** + Bachelor's degree preferred or a combination of professional work experience and education. **Pay Range** The typical pay range for this role is: $67,900.00 - $199,144.00… more
- Cardinal Health (Tallahassee, FL)
- …with long- and short-range changes in the reimbursement environment including Medicare , Medicaid, Managed Care, and Commercial plans while planning for various ... scenarios that may impact the manufacturer's product **TRAINING AND WORK SCHEDULES:** Your new hire training will take place 8:00am-5:00pm CST, mandatory attendance is required. This position is full-time (40 hours/week). Employees are required to have… more