- Sumitomo Pharma (Tallahassee, FL)
- …dynamic, highly motivated, and experienced individual for the position of Sr. Manager , Medicaid Contract Administration. This position is responsible for ... managing the Medicaid rebate team in receiving, processing, validating, trouble-shooting ...with internal departments (Internal Audit, Commercial Insights, Contracting, SOX Compliance , and Legal) to clarify policy compliance … more
- Humana (Tallahassee, FL)
- …development; and + Creating and executing comprehensive test plans + Ongoing Medicaid pricer maintenance, quality assurance, and compliance + Determining root ... a part of our caring community and help us put health first** The Medicaid (PPS) Provider Hospital Reimbursement Analyst also known as a Senior Business Intelligence… more
- Prime Therapeutics (Tallahassee, FL)
- … with federal laws, state laws and standards of practice which govern the Medicaid Drug Rebate Program. + Ensures compliance with each State Medicaid ... passion and drives every decision we make. **Job Posting Title** Manager Rebate Pharmacy Operations **Job Description Summary** This position provides administrative… more
- Humana (Tallahassee, FL)
- …for a period up to 11 weeks. The Telephonic Behavioral Health Care Manager Intern will utilize Humana's Medicaid training and engage formerly acquired ... first? During the period of this unpaid internship, you will work with the Medicaid Clinical Services team to ensure interaction between the company and members are… more
- MyFlorida (Tallahassee, FL)
- …in either administrative, civil or criminal judicial proceedings. This position requires compliance with Florida Medicaid Fraud Control Unit Standard Operating ... in the Office of the Attorney General within the Medicaid Fraud Control Unit in Tallahassee, Florida. This position...adopted by the commission, attesting to his or her compliance with subsections (1)-(7). The affidavit shall be executed… more
- Humana (Tallahassee, FL)
- …caring community and help us put health first** The Agency Broker Relationship Manager develops and maintains relationships with small to large accounts. The Agency ... Broker Relationship Manager work assignments involve moderately complex to complex issues...sales process in all sales-oriented activities, including marketing, advertising, compliance , sales promotions, and training to achieve revenue targets.… more
- Datavant (Tallahassee, FL)
- …to realize our bold vision for healthcare. **Role Overview** As a Product Manager , Risk Adjustment Analytics Products, you will contribute to the strategy and ... and support value-based client delivery across Medicare Advantage, ACA, and Medicaid programs. The ideal candidate combines deep healthcare analytics expertise with… more
- Humana (Tallahassee, FL)
- …a part of our caring community and help us put health first** The Manager , Technology Solutions devises an effective strategy for executing and delivering on IT ... business initiatives. The Manager , We are seeking a highly skilled and motivated...a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at… more
- Humana (Tallahassee, FL)
- …help us put health first** Humana's Marketing organization is seeking a Senior Product Manager who specializes in Next Best Action (NBA) execution to join the team ... a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Humana (Tallahassee, FL)
- …us put health first** We're seeking a strategic, results-driven Lead Product Manager to design and deliver innovative clinical solutions that improve health outcomes ... a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- Cardinal Health (Tallahassee, FL)
- …* Process all patient applications in accordance to set policy, procedures and PHI compliance * Speak with manufacturer field team members on case updates via phone ... benefits management experience preferred with specific knowledge of Medicare, Medicaid and commercially insured payer common practices and policies, preferred… more
- CVS Health (Tallahassee, FL)
- …Dual Eligible Special Needs Plan (DSNP) members, who are enrolled in both Medicare and Medicaid . As a member of the care team, you will collaborate with members, the ... coordinating care for our members through close collaboration with the Care Manager , Social Worker, and other interdisciplinary team members. This role involves… more
- MyFlorida (Tallahassee, FL)
- …state and national workers' compensation claims data collection and reporting practices for compliance with federal (Centers for Medicare & Medicaid Services - ... 69L, Florida Administrative Code. + Two (2) or more years of claims handling, compliance , and knowledge of workers' compensation insurance. + One (1) or more years… more
- CenterWell (Tallahassee, FL)
- …CenterWell ACO and Medicare payment model programs via the Center for Medicare and Medicaid Services (CMS), such as ACO REACH, MSSP, and future models. Under general ... operations including program administration, contract oversight, process, performance improvement, compliance , governance, training, and more. Additionally, this role will… more
- CenterWell (Tallahassee, FL)
- …of outcome data, policy, procedure, and records issues. . Assure personal compliance with licensing, certification, and accrediting bodies. **Use your skills to make ... Medicine . Active and unrestricted DEA license . Medicare Provider Number . Medicaid Provider Number . Excellent verbal and written communication skills . Superior… more
- Surgery Care Affiliates (Tallahassee, FL)
- …class. + When the patient's insurance is Out of Network notify the manager immediately. Follow the Policies and Procedures when accepting Out of Network payers. ... + The Insurance Verifier will call each patient as part of center compliance with CMS Conditions for Coverage guidelines in contacting patient's prior to the… more
- Humana (Tallahassee, FL)
- …campus and datacenters. The primary responsibility of the Network Operations Manager will be to provide the highest quality network infrastructure environment ... for future budget forecasting and planning needs. + Communicate status updates to Manager of IT and other Senior business leaders where necessary. + Research and… more
- Humana (Tallahassee, FL)
- …information to the application at Humana's secure website. + Position reports to Manager , Technology Solutions, IT HPE - Digital Channels & Contact Centers + ... a better quality of life for people with Medicare, Medicaid , families, individuals, military service personnel, and communities at...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- CenterWell (Tallahassee, FL)
- …experience with pharmacy benefits management + Previous Commercial, Medicare and/or Medicaid experience + Previous clinical experience in managed care **Additional ... of home health services, and fourth largest pharmacy benefit manager , CenterWell is focused on whole-person health by addressing...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
- CenterWell (Tallahassee, FL)
- …experience with pharmacy benefits management + Previous Commercial, Medicare and/or Medicaid experience + Previous clinical experience in managed care **Additional ... of home health services, and fourth largest pharmacy benefit manager , CenterWell is focused on whole-person health by addressing...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more