- Humana (Tallahassee, FL)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members ... **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement… more
- Humana (Tallahassee, FL)
- …community and help us put health first** The Medical Director relies on medical background and reviews health claims . The Medical Director work ... Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an… more
- Humana (Tallahassee, FL)
- … management or utilization management . **Additional Information** Reports to a Lead Medical Director . The Medical Director conducts Utilization ... a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews preauthorization requests… more
- Merck (Tallahassee, FL)
- **Job Description** **Role Summary** The Regional Medical Scientific Director is a credentialed (ie, PhD, PharmD, DNP, MD) therapeutic and disease expert who ... SLs, including questions about Company products. The work of an Regional Medical Scientific Director is aligned to: Scientific Exchange, Research, Scientific… more
- Humana (Tallahassee, FL)
- …of our dynamic Wisconsin leadership team in this position as the Director , Consumer Service Operations. This position works with insurance companies, providers, ... members, and collection services in the settlement of claims through Call Center operations. Comprised of a team of claims associates researching & resolving the… more
- Western Digital (Tallahassee, FL)
- …of action. + Develop, formulate and coordinate property and casualty insurance claims control function at all locations. + Continue review of existing safety, ... environment, loss prevention, employment and security programs as related to the management of risk or accidental loss. + Maintain historical record of all losses,… more
- CVS Health (Tallahassee, FL)
- …improvement in market provider and member satisfaction results by partnering with medical management , marketing, finance, and service operations. + Ensuring ... has an exciting opportunity to join its leadership team as an Executive Director , Network Management supporting our Florida market for our Commercial, Medicare,… more
- Centene Corporation (Tallahassee, FL)
- …the Chief Medical Director to direct and coordinate the medical management , quality improvement and credentialing functions for the business unit. + ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a...performance improvement initiatives for capitated providers. + Assists Chief Medical Director in planning and establishing goals… more
- Humana (Tallahassee, FL)
- …help us put health first** The Corporate Medical Director relies on medical background and reviews health claims . The Corporate Medical Director ... of diverse scope and complexity ranging from moderate to substantial. The Corporate Medical Director provides medical interpretation and decisions about the… more
- Merck (Tallahassee, FL)
- …needs to support collaboration to further differentiate our portfolio. The Oncology Regional Medical Scientific Director , RMSD, is a credentialed (ie, MD, PhD, ... **Job Description** Our Medical Affairs team advances patient care by engaging...and scientific community. Scientific exchange does not include promotional claims about any drug, vaccine or biologic product. RMSDs… more
- Humana (Tallahassee, FL)
- …functions strategy. + Establishes and oversees Medicaid segment trend mitigation strategy ( claims and revenue management ) + Researches industry trends and ... part of our caring community and help us put health first** The Director , Medicaid Trend Mitigation Strategy provides data-based strategic direction to identify and… more
- Baylor Scott & White Health (Tallahassee, FL)
- … claims data to uncover trends and assist in managing and understanding incurred medical and pharmacy cost. - The Director will design, develop, and support ... **Position Overview:** Reporting to the VP, Value-based Care Analytics, the Director of Healthcare Economics and Trend Analytics will support the Baylor Scott &… more
- Takeda Pharmaceuticals (Tallahassee, FL)
- …to bring life-changing therapies to patients worldwide. Join Takeda as Associate Director , Global Labeling Lead where you will be responsible for the development ... guidance. **How you will contribute:** With guidance from leadership: Management of Labeling Cross-Functional Teams + Independently leads Labeling cross-functional… more
- CVS Health (Tallahassee, FL)
- …background in health care analysis methods and tools, clinical performance improvement ( Medical Loss Ratio/MLR, Medical Expenditure Management ), clinical ... health care more personal, convenient and affordable. **Position Summary** The Lead Director , Practice Transformation plays a key role by leading transformation of… more
- Prime Therapeutics (Tallahassee, FL)
- …with data consolidation and modeling + Prior PBM experience or experience working with medical claims , pharmacy claims , healthcare and/or benefits data + ... with business partners across client facing divisions, product/ project management , analytics, operations, and IT to enable data-driven strategic decisions.… more
- Prime Therapeutics (Tallahassee, FL)
- … management such as GitHub + Prior PBM experience or experience working with medical claims , pharmacy claims , and/or healthcare data + Experience in the ... **Responsibilities** + Under general supervision, analyze or produce reports of varied claims data to assess Prime's products and/or programs; utilize analytics to… more
- Mathematica (Tallahassee, FL)
- …or APCD claims data; EHR and/or HIE data; healthcare informatics; medical coding). * Ability to describe difficult technical problems and solutions to a ... data pipelines and analyses involving large administrative data sources such as state Medicaid claims and APCDs, as well as clinical data sources such as EHRs and… more
- Sedgwick (Tallahassee, FL)
- …and goals for cloud-based infrastructure services in conjunction with senior IT management . The Director Infrastructure Services - Cloud designs and drives ... This role is responsible for the overall planning and management of the company data center and corporate IT...benefits package is offered including but not limited to, medical , dental, vision, 401k and matching, PTO, disability and… more
- MyFlorida (Tallahassee, FL)
- …the operations of the Medicaid fiscal agent, including Medicaid claims process, billing procedures, reimbursement methodologies, encounter submissions, and provider ... Medicare policies, national Medicaid-related research and demonstration projects, Medicaid Medical Assistance program innovations for general and special populations,… more
- Prime Therapeutics (Tallahassee, FL)
- …) experience + Experience conducting complex analysis on large sets of pharmacy, claims , medical , and/or financial data + Basic to intermediate SAS coding ... adjust focus **Reporting Structure** + Reports to Manager or Director in the Network Management , Consulting Analytics...to Manager or Director in the Network Management , Consulting Analytics or Operations & Planning department Potential… more