• Grievance/ Appeals Analyst I

    Elevance Health (Miami, FL)
    … Analyst I** is an entry level position in the Enterprise Grievance & Appeals Department that reviews, analyzes and processes non-complex pre service and post ... **Title: Grievance/ Appeals Analyst I** **Virtual:** This role enables associates...requirements. + As such, the analyst will strictly follow department guidelines and tools to conduct their reviews. +… more
    Elevance Health (07/18/25)
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  • Clinical Appeals Nurse (RN)

    Molina Healthcare (Orlando, FL)
    …Utilization Management, Chief Medical Officer, Physicians, and Member/Provider Inquiries/ Appeals . + Provides training, leadership and mentoring for less ... **JOB DESCRIPTION** **Job Summary** Clinical Appeals is responsible for making appropriate and correct...has been made or upon request by another Molina department to reduce the likelihood of a formal appeal… more
    Molina Healthcare (07/20/25)
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  • Pharmacist, Utilization Management (UM)

    Molina Healthcare (FL)
    …(such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services ... The Pharmacist, UM will be responsible for reviewing coverage determinations and appeals in a timely, compliant, and accurate manner. The Pharmacist, UM will… more
    Molina Healthcare (07/19/25)
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  • Valuations Funds Manager

    CBRE (Orlando, FL)
    Valuations Funds Manager Job ID 215004 Posted 11-Apr-2025 Service line Advisory Segment Role type Full-time Areas of Interest Valuations/Appraisal Location(s) Dallas ... - United States of America **About The Role:** As a CBRE Valuation Funds Manager , you will independently prepare market value appraisals on real estate assets with… more
    CBRE (07/18/25)
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  • Medical Director, MSK Surgery

    Evolent (Tallahassee, FL)
    …to the support services review process. Responsible for the quality of utilization review determinations, including appeals . + Provides input into audit ... training classes as needed for new hires to educate and train on Utilization management system and Field Medical Director process, standards and resources. + Acts… more
    Evolent (05/20/25)
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  • Senior Pharmacist

    Highmark Health (Tallahassee, FL)
    …and testing processes in partnership with the pharmacy benefits manager . The successful candidate will possess excellent communication, analytical, and ... RESPONSIBILITIES** + Monitor FDA-approvals, drug manufacturer pipelines, assess drug utilization reports, and write drug monographs for Committee review to… more
    Highmark Health (06/26/25)
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