- AdventHealth (Maitland, FL)
- …coordinating depositions, and participation in any trial or hearing. . Audits existing Managed Care agreements for payer compliance with terms, timely ... This position will be responsible for execution of the managed care payor dispute resolution processes for...dispute resolution processes. The position reports to the Executive Director of Reimbursement and Compliance . Experience in… more
- University of Miami (Medley, FL)
- …. The Department of Business Development and Managed Care is currently seeking an Executive Director , Managed ... work at our offices in Medley, Florida. The Executive Director , Managed Care Operations develops,...auditing process of hospital and physician managed care contracts to measure and maintain compliance .… more
- Molina Healthcare (Miami, FL)
- … healthcare experience + Understanding of the drivers and strategies across functions in managed care organizations (MCOs) as well as broad knowledge of the ... Duties** + Develops enterprise and domain-specific strategies to drive growth, compliance , and performance improvement within current business units + Leads… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …+ Perform other projects, work, and activities as assigned by the Pharmacy Director Qualifications: + Managed Care experience preferred, but not ... of the Health Plan's Medicare Prescription Drug Program, including compliance and oversight of Medicare Part D laws, regulations...of, or currently enrolled in, residency program (PGY1) in managed care pharmacy, or pharmacy practice. +… more
- AdventHealth (Tampa, FL)
- …Division_ . AdventHealth Tampa, a faith-based not-for-profit 626-bed tertiary-level acute care hospital located in the uptown district of Tampa, Florida, specializes ... issues identified at quarterly JOC meetings at discretion of Director . Performs supervisory duties in the absence of the...all. Adheres to Florida Hospital West Florida Division Corporate Compliance Plan and to all rules and regulations of… more
- Humana (Tallahassee, FL)
- …services such as inpatient rehabilitation. **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed ... authorized. All work occurs with a context of regulatory compliance , and work is assisted by diverse resources which...size of region or line of business. The Medical Director conducts Utilization Management of the care … more
- Humana (Tallahassee, FL)
- …services (such as inpatient rehabilitation). **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed ... authorized. All work occurs within a context of regulatory compliance , and work is assisted by diverse resources, which...The clinical scenarios arise from outpatient, inpatient or post-acute care environments. The Medical Director will have… more
- Humana (Tallahassee, FL)
- …services such as inpatient rehabilitation. **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed ... authorized. All work occurs with a context of regulatory compliance , and work is assisted by diverse resources which...size of region or line of business. The Medical Director conducts Utilization Management of the care … more
- Humana (Tallahassee, FL)
- …services such as inpatient rehabilitation. **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage, Managed ... 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
- YesCare Corp (Tallahassee, FL)
- …medicine in the state of employment + Board certified in primary care specialty (Family Practice, Internal Medicine, Emergency Medicine, Public Health or ... Occupational Medicine) with administrative experience in corrections and/or managed healthcare delivery. + Current DEA registration. Board certified, eligible, or… more
- Humana (Tallahassee, FL)
- …+ 5 years of established, post-residency clinical experience + Knowledge of the managed care industry including Medicare, Medicaid and/or Commercial products + ... our caring community and help us put health first** The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals.… more
- Humana (Tallahassee, FL)
- …skills + 5 years of established clinical experience + Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products + ... 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… more
- Molina Healthcare (Tampa, FL)
- …* 3 years' experience in Utilization/Quality Program Management * 2+ years HMO/ Managed Care experience * Experience demonstrating strong management and ... dependency services and assists with implementing integrated Behavioral Health care management programs. **Knowledge/Skills/Abilities** Provides Psychiatric leadership for utilization… more
- Black & Veatch (Coral Gables, FL)
- **Solution Sales Director - Sustainability, Planning & Optimization** Date: Apr 30, 2025 Location: US Company: Black & Veatch Family of Companies **Together, we own ... + Bachelor's degree or relevant work experience + Has successfully managed multiple engagements simultaneously + Contributor or leader to acquire new… more
- Highmark Health (Tallahassee, FL)
- …year in Medical Management in a Health Insurance Plan; strong knowledge of managed care industry **LICENSES AND CERTIFICATION** **Required** + Medical Doctor or ... to peer discussions may be required. The incumbent ensures compliance to NCQA, URAC, CMS, DOH, and DOL regulations...Skills + General Computer Skills + Clinical Software + Managed Care **Language (Other than English)** None… more
- PruittHealth (Lutz, FL)
- …offices. 7. Identifies key referring personnel in hospitals, nursing homes, and managed care operations, along with opportunities to increase referral volume ... **JOB PURPOSE:** We have a new and exciting opportunity for an admissions director . We are looking for a driven sales professional who will develop early and… more
- CenterWell (Tallahassee, FL)
- …which you are required to practice + Eight (8) years of clinical experience in managed care or equivalent experience + Five (5) years' experience in effectively ... caring community and help us put health first** The Director Drug Trend and Pipeline Forecasting will be the...we provide customers simple, integrated solutions every time. We care for patients with chronic and complex illnesses, as… more
- Mass Markets (FL)
- …a trusted partner in the industry. We are seeking an experienced and visionary Director of Strategic Growth and Capture to lead and drive large-scale capture efforts ... bids. + Manage teaming agreements, NDAs, and resource allocation, ensuring compliance and alignment with organizational goals. + Collaborate with recruiting and… more
- Otsuka America Pharmaceutical Inc. (Tallahassee, FL)
- …through in-field visits and call and case monitoring, maintaining high standards of patient care + Collaborate closely with compliance and legal teams to ensure ... role will oversee nurse case managers, ensuring high-quality patient care and operational excellence in our support services, inclusive...adherence to regulations ensuring compliance with pharmaceutical regulations, HIPAA, and industry standards +… more
- Sevita (Jacksonville, FL)
- …for each person served. + Maintains a functional understanding of funding, managed care requirements, and licensing requirements for each person served. ... Directs a department or program responsible for delivering health care services to clients/individuals. Manages staff RNs, and works...Assures compliance with all federal and state licensing requirements and… more