- Highmark Health (Tallahassee, FL)
- …current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and ... **ESSENTIAL RESPONSIBILITIES** + Conduct electronic review of escalated cases against medical policy criteria, which may include telephonic peer to peer discussions,… more
- Humana (Tallahassee, FL)
- …of providing frameworks to maximize available resources to achieve growth. The ** Director ,** ** Medicaid Insurance Product Management and Wellness Strategy** will ... caring community and help us put health first** Humana Medicaid is seeking exceptional candidates to join our ...(10-25% of time) This position is open to working remote within the US but prefer the qualified candidate… more
- Humana (Tallahassee, FL)
- …a part of our caring community and help us put health first** The Director , Actuarial of Medicaid Pricing provides actuarial support across a broad range ... understanding of how organization capabilities interrelate across the function or segment. The Director , Actuarial of Medicaid Pricing may be responsible for any… more
- Humana (Tallahassee, FL)
- **Become a part of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and ... reviewing skilled nursing facility requests. The Medical Director provides medical interpretation...a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at… more
- Prime Therapeutics (Tallahassee, FL)
- …our passion and drives every decision we make. **Job Posting Title** Director , Specialty Clinical Solutions- RPH/PharmD required- REMOTE **Job Description ... Summary** Responsible for support and development of Medical Pharmacy program strategy as part of the Medical Pharmacy Business Development team. Responsible for… more
- Humana (Tallahassee, FL)
- …a part of our caring community and help us put health first** Director of Enterprise Information Protection (EIP) Cybersecurity Engineering focused on building a ... decentralized systems. * Google Cloud Professional Machine Learning Engineer * Agile Remote /WAH requirements: + WAH requirements: Must have the ability to provide a… more
- Humana (Tallahassee, FL)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of...of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical … more
- Humana (Tallahassee, FL)
- …a part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and ... preservice appeals. The Corporate Medical Director reviews cases of diverse scope...protect member PHI / HIPAA information This is a remote position reporting to Grievance and Appeals Director… more
- Humana (Tallahassee, FL)
- …for the development, implementation, and management oversight of the company's Medicare/ Medicaid Stars Program. The Associate Director , Stars Improvement, ... of how organization capabilities interrelate across department(s). The Associate Director , Stars Improvement, Clinical work focuses on areas of clinical… more
- Cardinal Health (Tallahassee, FL)
- …team is passionate about helping oncology practices navigate the future. The Director , Managed Care is responsible for strategy and management of managed care ... responsible to implement strategic initiatives related to payer contracts. The Director , Managed Care contributes to practice growth and profitability by providing… more
- HealthEdge Software Inc (Tallahassee, FL)
- …to solve critical needs in healthcare. This individual will report to the Chief Medical Officer of Healthedge (HE) and ensure that our clinical suite of products ... Committee for Quality Assurance), CMS (Centers for Medicare & Medicaid Services), URAC (Utilization Review Accreditation Commission) and other...Work across multiple time zones in a hybrid or remote work environment. + Long periods of time sitting… more
- Centene Corporation (Tallahassee, FL)
- …for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering ... advisory panel + Manages corporate QI Trilogy documents for Medicaid / Medicare and UMAC/QIC across entire pharmacy organization...plus holidays, and a flexible approach to work with remote , hybrid, field or office work schedules. Actual pay… more
- Prime Therapeutics (Tallahassee, FL)
- …every decision we make. **Job Posting Title** Health Data Analyst - Remote **Job Description** The Health Data Analyst provides information, analyses, and ... new products + May be responsible for Centers for Medicaid /Medicare Services reporting and analysis, including the management of...+ Experience working with large sets of pharmacy, claims, medical , and/or financial data + Previous experience in a… more
- Prime Therapeutics (Tallahassee, FL)
- …drives every decision we make. **Job Posting Title** Pharmacy Network Manager - Remote **Job Description** We are hiring for two Pharmacy Network Managers to join ... industry; including 3 years of managed care experience in medical or pharmacy network contracting + Must be eligible...+ Knowledge of and experience within health care/PBM industry, Medicaid , Medicare and health plans + Familiarity with contract… more
- MyFlorida (Tallahassee, FL)
- …Medicare policies, national Medicaid -related research and demonstration projects, Medicaid Medical Assistance program innovations for general and special ... the Medicaid State Plan, Agency communications, State Medicaid Director Letters, and vendor contracts. Program...considered for this position. This position is not a remote or telework position; it will have to report… more