- Evolent (Tallahassee, FL)
- …with leadership, management, and clinical staff to address complex cases and support decision-making. + Act as a key resource for Initial Clinical Reviewers, ... to the Utilization Management process, interpretation, guidelines and/or system support . + On a requested basis, may function as...by any state or federal health care program, including Medicare or Medicaid, and is not identified as an… more
- Prime Therapeutics (Tallahassee, FL)
- …identify compliance requirements, assess risks, and recommend compliant solutions that support enterprise goals + Conducts analysis to create written reports, ... Management organization, or within a highly regulated industry, including experience with Medicare , Medicaid, and the Affordable Care Act (ACA) + Must be eligible… more
- Molina Healthcare (St. Petersburg, FL)
- …Performs analysis across multiple states and lines of business ( Medicare , Medicaid, Marketplace ACA). **KNOWLEDGE/SKILLS/ABILITIES** + Compiling and organizing ... applicable risk models including the various CMS models for Medicare Advantage members, the HHS model for Commercial ACA...is easy to understand and provides insights needed to support strategic investment decisions + Research and develop reports… more
- ChenMed (Miami, FL)
- …Analyst is responsible for identifying and delivering data-driven insights and analytical support to executive leadership of ChenMed. Success in the role will be ... Care leadership and will make data-driven strategy recommendations in the Medicare Advantage and healthcare industry. This senior-level analyst position has the… more
- Humana (Pompano Beach, FL)
- …6 years of Health Services/Case Management Experience + Prior experience with Medicare & Medicaid recipients + Intermediate to advanced computer skills and ... its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage… more
- Elevance Health (Tampa, FL)
- …_, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office ... for ensuring regulatory compliance, operational readiness, and strategic alignment across Medicare -Medicaid integrated products. **How you will make an impact:** +… more
- Humana (Orlando, FL)
- …Florida, with at least 4 years of relevant experience + Prior experience with Medicare & Medicaid recipients + Minimum 2 years case management experience + Bilingual ... its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage… more
- Humana (Tallahassee, FL)
- …Management + Health Plan experience working with large carriers + Previous Medicare /Medicaid experience a plus + Certification in Case Management a plus (CCM) ... its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage… more
- Evolent (Tallahassee, FL)
- …to the Utilization Management process, interpretation, guidelines and/or system support . + Participates in on-going training per inter-rater reliability process. ... by any state or federal health care program, including Medicare or Medicaid, and is not identified as an...General Service Administration (GSA), or reprimanded or sanctioned by Medicare . + No history of a major disciplinary or… more
- Cleveland Clinic (Port Saint Lucie, FL)
- …clinical referral coordinators, nurse reviewers, social workers, administrative, clerical support , and day-to-day operations of the department. A caregiver in ... and understanding of utilization review requirements, discharge planning process, and Medicare regulations to help ensure timely and quality patient care. **A… more