- Evolent (Tallahassee, FL)
- …outcomes. **Collaboration Opportunities:** . Routinely interacts with leadership and management staff , other Physicians, and staff whenever a physician`s input ... of the request and provides clinical rationale for standard and expedited appeals . . Utilizes medical/clinical review guidelines and parameters to assure consistency… more
- Cardinal Health (Tallahassee, FL)
- …reviewing the physician's daily schedule and obtaining verification of patients' insurance benefits for their scheduled visits. They will also obtain authorization ... necessary & must be knowledgeable of a variety of Insurance Plans and Policie **Responsibilities** + Submit authorizations for...to not delay patient care. + Complete any pre-service appeals to obtain paying approval based on medical necessity.… more
- Evolent (Tallahassee, FL)
- …care aligned with clinical guidelines. + Collaborate with leadership, management, and clinical staff to address complex cases and support decision-making. + Act as a ... practices. + Provides clinical rationale for standard and expedited appeals . + Discusses determinations (peer to peer phone calls)...+ Ensures documentation of all communications with medical office staff and/or MD provider is recorded in a timely… more
- Bristol Myers Squibb (Tampa, FL)
- …for escalation and resolution of Tier 2 queries, plan interpretation and appeals . + Responsible for ensuring internal processes are documented and updated versions ... Financial protection benefits such as short- and long-term disability, life insurance , supplemental health insurance , business travel protection and survivor… more
- Elevance Health (Miami, FL)
- …Associate Medical Director** is responsible for supporting the medical management staff ensuring timely and consistent medical decisions to members and providers. ... 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)
- …May identify cost of care opportunities. May serve as a resource to staff including Medical Director Associates. **How you will make an impact:** + Supports ... a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any… more
- Elevance Health (FL)
- …May identify cost of care opportunities. May serve as a resource to staff including Medical Director Associates. May be responsible for an entire clinical program. ... a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any… more
- Elevance Health (Tallahassee, FL)
- …+ May also serve as mentor, subject matter expert or preceptor for new staff , assisting in the formal training of associates, and may be involved in process ... + Assists and participates in appeal or fair hearings, member grievances, appeals , and state audits. **Minimum Requirements:** + Requires BA/BS degree and a… more
- Elevance Health (Miami, FL)
- …**Medical Director, Cardiology** is responsible for supporting the medical management staff ensuring timely and consistent medical decisions to members and ... for services requested. + Makes medical necessity determinations for grievance and appeals appropriate for their specialty. + Ensures consistent use of company… more