• Director of Medicare Risk Adjustment…

    Elevance Health (Tampa, FL)
    ** Director of Medicare Risk Adjustment Analytics and Reporting** **Location:** Alternate locations may be considered. This position will work a hybrid model ... will live within 50 miles of our Elevance Health PulsePoint locations. The ** Director of Medicare Risk Adjustment Analytics and Reporting** is responsible for… more
    Elevance Health (01/25/25)
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  • Medical Director

    Molina Healthcare (St. Petersburg, FL)
    …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
    Molina Healthcare (01/21/25)
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  • Director , US Market Access Marketing…

    Pfizer (Tampa, FL)
    ** Director , US Market Access Marketing Oncology, Sasanlimab and Mevrometostat** **ROLE SUMMARY** The incumbent, within the US Market Access Marketing (USMA-M) team, ... development of the Customer/Brand engagement strategy for top accounts within Commercial, Medicare , and other channels as appropriate based on clinical and economic… more
    Pfizer (01/24/25)
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  • Director , Formulary Strategy Development

    Elevance Health (Tampa, FL)
    …care. CarelonRx's Pharmaceutical Rebates Org is looking to hire a ** Director , Formulary Strategy Development.** This high-performing individual contributor will play ... in driving affordability across multiple lines of business (Commercial, Medicaid, Medicare , ASO clients) by partnering with internal and external stakeholders to… more
    Elevance Health (01/22/25)
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  • Executive Director of Quality

    AdventHealth (Tampa, FL)
    …six story surgical and patient care tower which will ensure state of the art medical and surgical car for generations to come . Awarded the Get With The Guidelines ... as a Primary Stroke Center. **The role you'll contribute:** The Executive Director will be responsible for: . Leading, planning, directing and coordinating the… more
    AdventHealth (01/03/25)
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  • Director , SIU / Fraud Waste and Abuse…

    Molina Healthcare (St. Petersburg, FL)
    …Access, Word and Excel * Knowledge and understanding of claims processing systems and medical claims * Knowledge of HMO, PPO, POS, MCO, Medicare , Medicaid, ... Market Place products, laws, rules and regulations **Preferred Education** * Master's degree **Preferred Experience** * Formalized training/experience in Health Care Insurance Fraud * Experience with Power BI, SAS, SQL other reporting software * ICD-10 CPT-4,… more
    Molina Healthcare (01/21/25)
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  • Medical Management Clinician Associate

    Elevance Health (Tampa, FL)
    …+ May process a medical necessity denial determination made by a Medical Director . + Refers complex or non-routine reviews to more senior nurses ... organization with health plans for people enrolled in Medicaid and/or Medicare programs in Florida. ** Medical Management Clinician Associate** **Location:**… more
    Elevance Health (01/18/25)
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  • Clinical Education Coordinator

    HCA Healthcare (St. Petersburg, FL)
    …and retirement of our colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no cost or for a low ... health coverage as well as free telemedicine services and free AirMed medical transportation. + Additional options for dental and vision benefits, life and… more
    HCA Healthcare (01/07/25)
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  • Program Manager (GUIDE Model), LSW or RN

    Bluestone Physician Services (Tampa, FL)
    …an evidence-based approach focused on quality care management and data-driven medical decisions, Bluestone care teams collaborate to manage patients' chronic ... (ACO) was the best performing ACO in the country (https://bluestonemd.com/2023/09/bluestone-aco-delivers-excellent-care-to-medically-complex-elderly-patients-saves- medicare -26-6-million/) as measured by the overall savings per … more
    Bluestone Physician Services (12/22/24)
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