- Humana (Tallahassee, FL)
- …This role will work horizontally across the organization, coordinating with Medicaid and Medicare leadership and clinical subject matter experts to synthesize, ... growth partners to design and optimize clinical operating model blueprints for viable Medicaid health plans that meet the needs of state clients and populations… more
- Humana (Tallahassee, FL)
- …deliver quality and value in a fast-paced, dynamic environment to support our Medicaid program through engaging in the transformation of clinical data to inform ... make an impact** **Responsibilities:** + Become an expert in HEDIS and Medicaid specifications, processes, and schedules + Partner to develop comprehensive … more
- Humana (Tallahassee, FL)
- …a part of our caring community and help us put health first** The Medicaid Actuary role is responsible for providing actuarial support for multiple states in ... are the specific day to day responsibilities of the Medicaid Actuary role: + Frequent analysis of actual experience...of technical experience + 2 or more years of project leadership experience **Scheduled Weekly Hours** 40 **Pay Range**… more
- Humana (Tallahassee, FL)
- **Become a part of our caring community and help us put health first** The Project Manager 2 manages all aspects of a project , from start to finish, so that it ... is completed on time and within budget. The Project Manager 2 work assignments are varied and frequently require interpretation and independent determination of the… more
- Humana (Tallahassee, FL)
- …a part of our caring community and help us put health first** The Associate Actuary role is a role within the Insurance Products Actuarial Medicare Advantage ... ad hoc projects and analysis to help enhance Part D accuracy. The Associate Actuary, Pricing work assignments involve moderately complex to complex issues where the… more
- Humana (Tallahassee, FL)
- …of our caring community and help us put health first** The Associate Actuary, Analytics/Forecasting analyzes and forecasts financial, economic, and other data to ... short, medium and long-term financial and competitive position. The Associate Actuary, Analytics/Forecasting work assignments involve moderately complex to complex… more
- Highmark Health (Tallahassee, FL)
- …underlying systems that support the respective business platforms for the Medicaid Business Unit market served by Highmark. Performs configuration change management ... the most complex issues in order to understand capability needs, gather project specifications, create business cases and cost sheet analysis, translate high-level… more
- Humana (Tallahassee, FL)
- …experience + 5 years or more years of experience in Medicare, Medicaid , risk management and/or legislative/regulatory guidance + Project leadership experience ... reviewing regulatory changes and new rules pertinent to the Medicaid line of business. Your primary focus will be...Point (ESP) **Additional Information** You will report to the Associate Director of Operational Risk Management. This area is… more
- Humana (Tallahassee, FL)
- …for meticulously reviewing regulatory changes and new rules pertinent to the Medicaid line of business. Your primary focus will be to identify requirements ... guidelines, many with diverse scope and complexity + Develop detailed implementation project plans in accordance with departmental standards + Facilitate work groups… more
- Humana (Tallahassee, FL)
- …Support (LTSS)/Long Term Care (LTC) providers for the Illinois Medicare - Medicaid Alignment Initiative (MMAI) plan. The Senior Market Development Professional work ... decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. **Use your skills to… more
- Humana (Tallahassee, FL)
- …of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ ... in a medical management review organization, such as Medicare Advantage, managed Medicaid , or Commercial health insurance. + Experience with national guidelines such… more
- Humana (Tallahassee, FL)
- …of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ ... in a medical management review organization, such as Medicare Advantage, managed Medicaid , or Commercial health insurance. + Experience with national guidelines such… more
- Humana (Tallahassee, FL)
- …of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ ... in a medical management review organization, such as Medicare Advantage, managed Medicaid , or Commercial health insurance. + Experience with national guidelines such… more
- CenterWell (Tallahassee, FL)
- …on moderately complex to complex issues regarding the technical approach for project components and work without direction. The Senior Healthcare Risk Professional ... senior management, or regulatory agencies as required. + Ensures that project /department milestones/goals are met. + Contributes to annual and longer-range… more
- Humana (Tallahassee, FL)
- …years of technical experience in Data analysis + 2 or more years of project leadership experience + Advanced experience working with complex data sets within large ... ability to work with cross-functional teams and translate requirements between business, project management and technical projects or programs. + SSIS or ASA ETL… more
- Humana (Tallahassee, FL)
- …analytic solutions. The Stars program is the Centers for Medicare & Medicaid Services (CMS) five‐star quality rating system for measuring Medicare beneficiaries' ... improve the decision-making experience for stakeholders + 2 or more years of project leadership experience + Experience analyzing data to solve a wide variety of… more
- Humana (Tallahassee, FL)
- …+ Master's Degree or higher in Computer Science or a related field + Associate or Professional level solution architecture certification in Azure, GCP and/or AWS. + ... in Enterprise Architecture repository tools like iServer + 2+ years of project leadership and consulting experience. + Health Care Business Domains - Medicare,… more
- Humana (Tallahassee, FL)
- …Management Professional is part of the Service Excellence team within Enterprise Associate and Business Solutions. Service Excellence plays a pivotal role in the ... with reporting, data, technology solutions and business analytics. The Enterprise Associate and Business Solutions (EABS) organization forms part of the Chief… more
- Humana (Tallahassee, FL)
- …to the decision making on complex issues regarding technical approach for project components, and works on model building use cases with minimal supervision. ... to related areas + Compile and present regular and ad-hoc project status reports + Follow established guidelines/procedures **Required Qualifications** + Master's… more
- Humana (Tallahassee, FL)
- …moderately complex to more complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable ... equivalent + 8+ years of technical network engineering experience + 5+ years of project leadership experience. + 8+ years of Layer 2/ Layer 3 network architectural… more