- Holland America Group (Miami, FL)
- …cannot. The Love Boat promises something for everyone. We are looking for an amazing Director , Guest Claims Management to fill this role, which is based ... and fosters collaboration with the ships, Safety, Security and Medical to make corrections to the areas giving rise...summary of what Princess is looking for in its Director , Guest Claims Management Is… more
- Great American Insurance Group (Lakeland, FL)
- …plans for complex claims referred by the managed care team, discuss claims management with treating physicians, and advise internal nurse case managers on ... (MDs, RNs) when required. Explore and disseminate significant updates/changes in internal medical policies to claims managers and the managed care team.… more
- South Florida Regional Transportation Authority (Pompano Beach, FL)
- …Information Technology Location: Pompano Beach, FL Reports to: Deputy Executive Director FLSA Status: Exempt Position Salary Range: $106,573 - $207,682 FLSA ... and policies to ensure data integrity, security, and regulatory compliance. Budget Management : Develop and manage the IT budget, including cost-benefit analysis and… more
- Carnival Cruise Line (Miami, FL)
- …cannot. The Love Boat promises something for everyone. We are looking for an amazing Director , Guest Claims Management to fill this role, which is based ... and fosters collaboration with the ships, Safety, Security and Medical to make corrections to the areas giving rise...summary of what Princess is looking for in its Director , Guest Claims Management Is… more
- Elevance Health (Tampa, FL)
- **Clinical Documentation and Claims Integrity Director ** **Location:** Alternate locations may be considered. This position will work a hybrid model (remote and ... The ideal candidate has experience working in leading healthcare payer claims / revenue cycle management (RCM) organizations, with specific understanding… more
- Molina Healthcare (FL)
- …including 2 years in a manager role. * Experience reviewing all types of medical claims (eg CMS 1500, Outpatient/Inpatient, Universal Claims , Surgery, ... claims , COB and DRG/RCC pricing), and IPA. 2 years supervisory/ management experience with appeals/grievance processing within a managed care setting. **Preferred… more
- AdventHealth (Altamonte Springs, FL)
- …and CAR are included in the electronic file to support the actions and claims management decisions. + Sets, maintains and justifies appropriate reserves and ... EXPERIENCE REQUIRED:** + Bachelor's degree in Nursing, Business Administration, insurance claims management , sociology, psychology, or human behavior studies… more
- USAA (Tampa, FL)
- …truly makes us special and impactful. **The Opportunity** As a dedicated Claims Litigation Manager Senior (Western States), you will responsible for **managing ... resource for colleagues with less experience. + Applies advanced knowledge of claims litigation processes. + Proactively manages litigation and acts as liaison with… more
- Otsuka America Pharmaceutical Inc. (Tallahassee, FL)
- …medicines for those with CNS disorders, we are seeking a skilled and experienced Medical Director of CNS Early Assets, Global Medical Affairs, responsible ... , Franchise Lead CNS Early Assets. **Position Summary:** The Medical Director , Global Medical Affairs,...for any assigned assets in development. + Support lifecycle management initiatives and planning for assigned assets as applicable.… 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)
- …community and help us put health first** The Medical Director relies on medical background and reviews health claims . The Medical Director work ... value based care, population health, or disease or care management . **Responsibilities** The Medical Director provides medical interpretation and… more
- Community Health Systems (Naples, FL)
- The **System Director of Risk Management ** is a key leader responsible for overseeing risk management , patient safety, and regulatory compliance across ... collaborate with one to support quality and safety initiatives. ** Claims & Litigation Management ** + Oversee legal...standards in patient safety and quality care The **System Director of Risk Management ** is a vital… 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
- Otsuka America Pharmaceutical Inc. (Tallahassee, FL)
- **Position Summary:** The Associate Director of Global Medical Affairs Omnichannel will be responsible for developing and leading the omnichannel strategy for ... Global Medical Affairs across all therapeutic areas and brands. This...aligning with CoE training efforts + **Performance & Risk Management :** + Provide regular updates on the performance and… 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)
- …put health first** The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals. The Corporate ... Medical Director works on problems of diverse scope and complexity...focused on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience + Working with… 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 ... claims and appeals and resolves grievances related to medical quality of care. + Attends or chairs committees...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
- Otsuka America Pharmaceutical Inc. (Tallahassee, FL)
- …The Associate Director is responsible for the design, execution, and management of multiple market research engagements. In addition, the Associate Director ... **Job Summary** The Associate Director of Brand Analytics role for the ecosystem...that deliver exceptional results + Have strong analytical, project management , fiscal management and decision-making skills Have… more
- Wounded Warrior Project (Jacksonville, FL)
- …veterans' benefits or advocacy. + Three years of experience utilizing VA claims technologies (eg, Veterans Benefits Management System, Caseflow, Direct Upload) ... the office, two days' work from home) . Full medical , dental, and vision coverage for both teammates AND...for you. The Wounded Warrior Project (WWP) National Service Director leads and develops a team of benefits professionals… more
- Humana (Tallahassee, FL)
- …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 scope and complexity...focused on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience, + working with… more
