- CenterWell (Tallahassee, FL)
- …Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/ Medicare /Medicaid Experience a plus + Current nursing ... one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the… more
- Prime Therapeutics (Tallahassee, FL)
- …strategic plans that achieve Star Ratings and quality outcomes for Medicare , Medicaid, Individual Health Insurance Marketplace, and Commercial lines of business. ... the client quality support model strategy for all lines of business ( Medicare , Medicaid, commercial/HIM); serve as primary enterprise point of contact and subject… more
- Prime Therapeutics (Tallahassee, FL)
- …experience in legal or compliance related roles for a healthcare or Pharmacy Benefit Management organization, or within a highly regulated industry, including ... experience with Medicare , Medicaid, and the Affordable Care Act (ACA) +...related area of study, such as Juris Doctor + Medicare Part D, Medicaid, and/or Affordable Care Act knowledge… more
- CenterWell (Jacksonville, FL)
- …indicators (KPIs), such patient experience via Net Promoter Score (NPS) and Medicare clinical quality via HEDIS, meeting local and organizational goals + Personally ... care environment in a value-based relationship environment. + Knowledge of Medicare guidelines and coverage. + Knowledge of HEDIS quality indicators **Additional… more
- CenterWell (Tallahassee, FL)
- …quality and cost improvement for high-risk senior populations in full risk Medicare arrangements. This individual will help assess the value of each opportunity ... quality and value drivers in full risk care delivery, ideally in Medicare /seniors + Demonstrated ability to work collaboratively with clinical and operational… more
- Molina Healthcare (St. Petersburg, FL)
- …Responsibilities include research, analysis and modeling of complex healthcare claims data, pharmacy data, lab data, and Risk Adjustment submissions data to evaluate ... Performs analysis across multiple states and lines of business ( Medicare , Medicaid, Marketplace ACA). **KNOWLEDGE/SKILLS/ABILITIES** + Compiling and organizing… more
- CenterWell (Jacksonville, FL)
- …two to five years directly applicable experience preferred . Experience managing Medicare Advantage panel of patients with understanding of Best Practice in ... coordinated care environment in a value-based relationship environment . Knowledge of Medicare guidelines and coverage . Bilingual (English and Spanish) is a plus .… more
- CenterWell (Tallahassee, FL)
- …3 or more years experience in a high-volume community or mail order pharmacy practice environment + Previous experience in utilization management + Education: BSN or ... a related field + Health Plan experience + Previous Medicare /Medicaid Experience a plus + Call center or triage...largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health… more
- Lundbeck (Orlando, FL)
- …internal and external partners and effectively addresses payer access issues ( Medicare , Medicaid, Commercial) using Lundbeck resources. **Local Market & Therapeutic ... experience in both the Outpatient Infusion setting and Specialty Pharmacy channel with a strong understanding of pricing and...migraine + Experience in both the medical or specialty pharmacy benefit market + Experience working with high influence… more
- Centene Corporation (Tallahassee, FL)
- …referral + Ensure assignment of benefits are obtained and on file for Medicare claims + Bill insurance companies for therapies provided + Document all pertinent ... payors and prior authorization preferred. **Foundation Care Only:** Missouri Registered Pharmacy Technician is preferred, but not requiredPay Range: $15.58 - $26.73… more