- Elevance Health (Miami, FL)
- …**How you will make an impact** : + Ensures timely completion of clinical case reviews for their board certified specialty. + Makes physician to physician calls to ... for services requested. + Makes medical necessity determinations for grievance and appeals appropriate for their specialty. + Ensures consistent use of medical… more
- Elevance Health (Miami, FL)
- …with providers and external physicians. + May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss ... and quality. + Works independently with oversight from immediate manager . + May be responsible for an entire clinical...the United States when conducting utilization review or an appeals consideration and cannot be located on a US… more
- MyFlorida (Sarasota, FL)
- …position requires research and reviews are in areas of law including appeals from county court (both civil and criminal), complex civil litigation, constitutional ... skills and abilities listed below: Knowledge: Legal principles, statutory and case law, court rules and procedures, legal publications, Florida State Courts… more
- Elevance Health (Tampa, FL)
- …necessity of requests using clinical criteria. + Performs physician-level case review of musculoskeletal utilization requests. + Conducts peer-to-peer consultation ... alternative surgical and non-surgical treatments. + Performs first level provider appeals of coverage decisions. + Provides support and education to internal… more