- 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 (St. Petersburg, FL)
- …3+ years HMO/Managed Care experience **OR** 5 years experience as a Molina Medical Director + Demonstrated experience in Utilization/Quality Program management + ... Summary** Responsible for serving as the primary liaison between administration and medical staff. Assures the ongoing development and implementation of policies and… more
- Molina Healthcare (St. Petersburg, FL)
- JOB DESCRIPTION Job Summary Provides medical oversight and expertise in appropriateness and medical necessity of services provided to members, targeting ... and cost-effective member care. Essential Job Duties * Determines appropriateness and medical necessity of health care services provided to plan members. * Supports… more
- Molina Healthcare (St. Petersburg, FL)
- **JOB DESCRIPTION** **Job Summary** Responsible for analysis of Medicaid and Medicare financial reports, trend, and opportunities. Includes evaluation of and ... recommendations relating to business opportunities, Medicare bids, investments, financial regulations, and similar financial projects...early signs of trends or other issues related to medical care cost. + Design and perform actuarial studies… more
- Humana (Clearwater, FL)
- …of everything it does. The MarketPoint Career Channel Team is looking for skilled Medicare Field Sales Agents. This is a field-based role, and candidates must live ... community. As part of a collaborative team of 8-12 Medicare Sales Agents, you'll work under the guidance of...under the guidance of a Senior Manager and Regional Director who are committed to your success. Together, you'll… more
- 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 (St. Petersburg, FL)
- …Certification in Psychiatry **REQUIRED EXPERIENCE:** * 2 years previous experience as a Medical Director in clinical practice * 3 years' experience in ... (TX) Medical License, free of sanctions from Medicaid or Medicare . **Preferred Experience** * Peer Review, medical policy/procedure development, provider… more
- Molina Healthcare (St. Petersburg, FL)
- …reviews behavioral health portions of state contracts. * Assists behavioral health medical director lead trainers in the development of enterprise-wide education ... JOB DESCRIPTION Job SummaryProvides medical oversight and expertise related to behavioral health...National Committee for Quality Assurance (NCQA) and Centers for Medicare and Medicaid Services (CMS). * Assists with the… more
- AdventHealth (Tampa, FL)
- **Basic Function** The Fellowship Program Director , in accordance with the specific accreditation body, has responsibility and accountability for the operation of ... well-being. + Oversight of scholarly activities The Fellowship Program Director reports to the Sponsoring Institution's Chief Academic Officer/Designated… more
- Grifols Shared Services North America, Inc (Clearwater, FL)
- …and services in more than 110 countries and regions. The Associate Director , Value Access Marketing & Reimbursement is responsible for developing and executing ... access customer segment . Support reimbursement, coding, and coverage-related responsibilities for Medicare Part B, Centers for Medicare and Medicaid (CMS)… more
- HCA Healthcare (Tampa, FL)
- …in 21 states and the United Kingdom. We are looking for a Division Director of Regulatory and Accreditation for our HCA Healthcare team where excellence creates ... 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… more
- Danaher Corporation (Tampa, FL)
- …the Danaher Business System which makes everything possible. The Field Reimbursement Director position is a provider / customer facing role responsible for ... coordinate and engage targeted customers within the US. Reporting to the Senior Director of Market Access Americas, this highly visible role will play a pivotal… more
- IQVIA (Tampa, FL)
- Job Description Summary: **Associate Director Finance Operations** Directs financial planning and accounting practices including budgeting, costing, financial ... financial application software is essential. Understanding of **PBM systems and Medicaid/ Medicare billing.** + **Familiarity with NCPDP standards.** + **Knowledge of… more
- USAA (Tampa, FL)
- …makes us special and impactful. **The Opportunity** USAA is seeking a talented ** Director , Retirement Income** to lead multiple teams of Health, Life or Retirement ... with Legal, Risk and Compliance on interpretation of CMS (Center for Medicare and Medicaid Services) rules to provide guidance and clarification to executive… more
- Molina Healthcare (St. Petersburg, FL)
- …and Joint Operating Committees. * Manages and reports network adequacy for Medicare , Marketplace, and Medicaid services. * In conjunction with direct management and ... recontracting initiatives. Implements cost control initiatives to positively influence the Medical Care Ratio (MCR) in each contracted region. * Leads preparation… more
- ChenMed (Clearwater, FL)
- …specific geographic regions. This individual will report to and work with the Network Director to develop the CPL and serve as the local relationship builder with ... Specialty, MED COE and HCT leaders to support improved medical costs and specialty care utilization. This individual will...individual will report to and work with the Network Director to develop the CPL and serve as the… more
- CenterWell (Safety Harbor, FL)
- … medical expertise with the care team through daily huddles. . Helps regional medical director and center administrator in setting a tone of cooperation in ... doctors, advanced practice professionals, pharm D, care coach nurses, medical assistants, behavioral health, specialists, quality-based coders, referral coordinators… more
- ChenMed (St. Petersburg, FL)
- …housing managers, senior centers and related community providers to keep ChenMed/JenCare Medical Centers as their top provider choice for senior healthcare when ... handle additional sustained monthly production, developing better working relationships with Center Director , Director of Growth and other market leaders and… more
- AdventHealth (Tampa, FL)
- …All while understanding that **together** we are even better. **Location:** **3000 MEDICAL PARK DR, Tampa, 33613** **The community you'll be caring for:** ... AdventHealth Medical Group Zephyrhills & Dade City **The role you'll...DNV, United Network for Organ Sharing (UNOS), Centers for Medicare and Medicaid Services (CMS), and Interagency Registry for… more
- CenterWell (Tampa, FL)
- …audits/billing are completed timely and in compliance with Medicare regulations. + Coordinates communication between team members/attending physicians/caregivers ... of care and outcome planning. + Works in conjunction with the Branch Director and Company Finance Department to establish location's revenue and budget goals. +… more