- 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)
- …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
- 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 Specialty Clinical Solutions team.… 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
- CVS Health (Tallahassee, FL)
- …**Position Summary** CVS Health, a Fortune 6 company, has an outstanding opportunity for a Medical Director - Medical Affairs. We need a Double Board ... clinical product development, Enterprise Analytics, Compliance, Legal, Accreditation) and clients. The Medical Director ( Medical Affairs) will report into… 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 works on problems of diverse...+ Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products + Must be passionate… more
- Humana (Tallahassee, FL)
- …a part of our caring community and help us put health first** Associate Director of Digital Experience Solutions (DES) Architecture In support of our vision to ... and to enable effectiveness and efficiency of technology decisions. The Associate Director of Digital Experience Solutions (DES) Architecture is a highly visible… more
- Humana (Tallahassee, FL)
- …Best Places to Work, and be a part of our dynamic team as the Director of Technology Solutions. We are on a mission to revolutionize our Customer Relationship ... this pivotal role is your chance to make a substantial impact! As the Director of Technology Solutions, you will spearhead the strategy and execution of IT… 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
- CVS Health (Tallahassee, FL)
- …health care more personal, convenient and affordable. **Position Summary** As the Director of Commercialization and Growth, part of the Health Care Delivery business ... sales strategies and growth objectives. Note**:** _This is a remote role and can be anywhere in the continental...Experience in Managed Care space (Medicare Advantage or Managed Medicaid ) a plus. + Knowledge of health plan economics… 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
- MyFlorida (Tallahassee, FL)
- …Medicare policies, national Medicaid -related research and demonstration projects, Medicaid medical assistance program innovations for general and special ... 68064844 - MEDICAL /HEALTH CARE PROGRAM ANALYST Date: Sep 19, 2024...the Medicaid State Plan, Agency communications, State Medicaid Director Letters, and vendor contracts. Program… more
- Centene Corporation (Tallahassee, FL)
- …for appeals, adjustments and miscellaneous/unlisted code review + Review cases with Medical Director to validate decisions and identify opportunities to create ... NOTE: This fully remote role involves reviewing provider disputes and researching medical records across all our lines of business. Preference will be given to… more