- Elevance Health (Miami, FL)
- … medical necessity decisions. + Brings to their supervisors attention, any case review decisions that require Medical Director review or policy ... + Minimum of 1 year of experience with clinical case reviews for medical necessity. _The minimum...and Interventional Pain specialties._ + Board certification in a medical specialty required. ** Preferred Skills, Capabilities, and… more
- Humana (Lake Wales, FL)
- …often straightforward and of moderate complexity. **We are looking for motivated and dynamic case managers that enjoy making a difference in the lives of others in ... meet those needs + Coordinating services, and monitoring and evaluating the case management plan against the member's personal goals + Guides members/families… more
- Highmark Health (Tallahassee, FL)
- …+ 5 years in Clinical, Direct Patient care (hospital, outpatient, or private practice) ** Preferred ** + 1 year in Medical Management in a Health Insurance Plan; ... standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical...Preferred ** + None **SKILLS** + Critical Thinking + Case Management + Customer Service + Oral & Written… more
- Fujifilm (Tallahassee, FL)
- …effectively communicate with our customers, and document the interactions within a case . + Works cross-functionally with other Synapse teams/products as required and ... maintained. + Positive customer surveys, documentation accuracy and consistency, timely case and project completion, and finishing the assigned trainings are… more
- Datavant (Tallahassee, FL)
- …for this role possesses high attention to detail and a depth of knowledge in medical terminology. This role is fully remote with a flexible schedule, allowing you to ... ICD-9-CM, ICD-10-CM, and ICD-10-PCS codes + Accurately sequence and abstract medical codes from patient records, ensuring precision and adherence to documentation… more
- Fujifilm (Tallahassee, FL)
- …effectively communicate with our customers, and document the interactions within a case . + Works cross-functionally with other Synapse teams/products as required and ... maintained. + Positive customer surveys, documentation accuracy and consistency, timely case and project completion, and finishing the assigned trainings are… more
- Humana (Tallahassee, FL)
- …a part of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home ... health, DME, skilled nursing facility and waiver requests. The Medical Director provides medical interpretation and determinations whether services provided by… more
- Humana (Tallahassee, FL)
- …a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make ... reference materials, internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and Medicare Advantage requirements, and… more
- Humana (Tallahassee, FL)
- **Become a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The ... of situations or data requires an in-depth evaluation of variable factors. The Medical Director actively uses their medical background, experience, and judgement… more
- Elevance Health (Miami, FL)
- … medical necessity decisions. + Brings to their supervisors attention, any case review decisions that require Medical Director review or policy ... make an impact:** + Ensures timely completion of clinical case reviews for their board certified specialty. + Makes...+ Requires an MD and Board certification in a medical specialty required. ** Preferred Skills, Capabilities, and… more
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