- MyFlorida (Tallahassee, FL)
- 68059454 - MEDICAID MANAGEMENT REVIEW MONITOR Date: Jun 6, 2025 The State Personnel System is an E-Verify employer. For more information click on our ... No: 854649 Agency: Agency for Health Care Administration Working Title: 68059454 - MEDICAID MANAGEMENT REVIEW MONITOR Pay Plan: Career Service Position… more
- MyFlorida (Tallahassee, FL)
- …activities for quality review , utilization management and quality monitoring and review of specific types of Medicaid services in order to assist in ... and planning entity. The Agency is responsible for administering the Florida Medicaid program, the licensure and regulation of nearly 50,000 health care facilities,… more
- MyFlorida (Tallahassee, FL)
- …be found on the Agency's administrative rule webpage at http://ahca.myflorida.com/ medicaid / review /index.shtml. 8. Providing technical assistance to ensure ... and planning entity. The Agency is responsible for administering the Florida Medicaid program, the licensure and regulation of nearly 50,000 health care facilities,… more
- Prime Therapeutics (Tallahassee, FL)
- …+ 8 years of relevant client services experience in healthcare or pharmacy benefit management , preferably in Medicaid . + 5 years of leadership / people ... drives every decision we make. **Job Posting Title** Senior Director Clinical Account Management - Remote **Job Description** The Sr Director of Clinical Account … more
- MyFlorida (Fort Lauderdale, FL)
- …and processing changes of ownership in APD iConnect. The Work You Will Do Review incoming Medicaid Waiver provider application packets and notify applicant of ... subtleties of group dynamics. This position with APD will serve staff and management across the Agency. Your work will impact the workplace culture, our community,… more
- University of Miami (Hialeah, FL)
- …staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . Performs ... hospital leadership, and quality leadership to effectively facilitate appropriate data management , timely and accurate reporting of data and outcomes, accurate… more
- CVS Health (Tallahassee, FL)
- …of Nursing experience. Preferred Qualifications + Prior authorization utilization management / review experience preferred Outpatient Clinical experience. + ... skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for… more
- Molina Healthcare (FL)
- …practice. + Utilizes IT and data analysts to produce tools to report, monitor and improve Utilization Management . + Actively participates in regulatory, ... development, provider contracting experience. + Experience with NCQA, HEDIS, Medicaid , Medicare and Pharmacy benefit management , Group/IPA practice,… more
- Prime Therapeutics (Tallahassee, FL)
- …business (Employer Markets, Health Insurance Marketplace (HIM), Commercial, Medicare, and Medicaid ). This individual is the primary relationship and contract owner ... for their assigned account/s and oversees a cross-functional account management team, including representation across all lines of business, and key departments such… more
- Prime Therapeutics (Tallahassee, FL)
- …notifications, and periodic reports related to licensed functions (Pharmacy Benefit Management (PBM), Third Party Administrator, Utilization Review Organization, ... their designated areas. This role partners with key internal stakeholders to monitor aspects of compliance and validate policies, procedures, licensure, and program… more