- CVS Health (Coral Gables, FL)
- …to, claims payment, contract interpretation or parameters, and accuracy of provider contract or demographic information are resolved. + Supports or assists ... design, contract language, service, claims or compensation issues, and provider education needs. + Optimizes interactions with assigned providers and internal… more
- Molina Healthcare (Orlando, FL)
- …outcomes and financial performance of the product. Contributes to overarching strategy to provide quality and cost -effective member care . **ESSENTIAL JOB ... regulations. **REQUIRED QUALIFICATIONS:** + At least 12 years of experience in health care leading state Medicaid long-term care services programs in a… more
- Centene Corporation (Tallahassee, FL)
- …health plans in periodic analyses of their provider networks from a cost , coverage, and growth perspective. + Provide leadership in evaluating opportunities ... hospitals and ancillaries). Support market expansion and M&A activities by leading provider contract analysis related to due diligence. + Assist health… more
- Veterans Affairs, Veterans Health Administration (Jacksonville, FL)
- …that address issues and provide standards relevant to the delivery of specialty care at the OPC and CBOC. Promotes the provision of easy access to medical ... a Physician to serve as Associate Chief Of Staff (ACOS) for Specialty Care at the Jacksonville Outpatient Clinic, in Jacksonville, Florida. The ACOS/Specialty … more
- Molina Healthcare (Orlando, FL)
- …claims data, pharmacy data, and lab data regarding network utilization and cost containment information. Evaluates, writes, and presents healthcare utilization and ... cost containment reports and makes recommendations based on relevant...materials and documentation archives. + Demonstrate Healthcare experience in contract modeling, analyzing relevant Financial and Utilization Metrics of… more
- Intermountain Health (Tallahassee, FL)
- …in care . Supports the efforts of providers and practice teams on office based care delivery interventions resulting in cost of care savings and improved ... and training techniques. Based on medical record metrics and contract obligations, conducts patient outreach and follow up in...the efforts of providers and practice teams on office-based care delivery interventions resulting in cost of… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …providers, and interdisciplinary teams to assess behavioral health needs, develop individualized care plans, and ensure cost -effective, quality care in ... are cost -effective and meet quality standards, consistent with managed care requirements and clinical best practices. + Maintain accurate and timely… more
- Molina Healthcare (Tampa, FL)
- …delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost -effective member care . Essential Job Duties * ... Assesses services for members to ensure optimum outcomes, cost -effectiveness and compliance with all state/federal regulations and guidelines. * Analyzes clinical… more
- Molina Healthcare (Fort Lauderdale, FL)
- …ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost -effective member care . Essential Job ... JOB DESCRIPTION Job Summary Provides support for care management/ care coordination activities and collaborates...licensure and/or certification required ONLY if required by state contract , regulation or state board licensing mandates. * Valid… more
- Molina Healthcare (Miami, FL)
- …underperforming and problematic contracts. Supports multi-dimensional pricing strategies to drive down total cost of care and minimize variation in cost by ... where appropriate. * Work independently to support and validate Provider Network contracting and unit cost management...((PowerPoint supported by Tableau/Power BI visuals). * Coordinate and provide peer review of quarterly VBC contract … more