- Elevance Health (Tampa, FL)
- **Behavioral Health Medical Director -Psychiatrist Appeals ** **Location:** This role enables associates to work virtually full-time, with the exception of ... - Friday. Half day Saturday rotation, once a month.** The **Behavioral Health Medical Director -Psychiatrist Appeals ** is responsible for the administration… more
- Humana (Tallahassee, FL)
- …clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments involve moderately complex to complex issues where the ... case consideration of the Medicare rules, Humana policies and medical necessity. The Medical Director ...includes computer based review of moderately complex to complex appeals for coverage for drugs using resources outlined above… more
- CVS Health (Tallahassee, FL)
- …And we do it all with heart, each and every day. **Position Summary** The Lead Director , Pharmacy Appeals will lead a team of 40+ colleagues in the management of ... as guiding other internal business units to resolve issues quickly. The Lead Director , Pharmacy Appeals is also responsible for working with the Presidential… more
- CenterWell (Tallahassee, FL)
- …compliance. Manages the Denials Management data analytics, denial and appeal process. The Director , Home Health Grievances & Appeals assists members, via phone ... caring community and help us put health first** The Director Denials Management provides leadership for the audit, appeal...required + Expert knowledge of all Medicare regulations and appeals processes + Excellent analytical skills with ability to… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …reporting variances in utilization of resources, avoidable days/denials. Works in collaboration with Appeals Management/ Medical Director in the appeals ... necessity for the requested level of care/patient status to the Medical Director . + Proactively identifies and resolves delays and obstacles for safe discharge.… more
- Humana (Tallahassee, FL)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... of service should be authorized at the Initial and Appeals /Disputes level. All work occurs within a context of...to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of… more
- Humana (Tallahassee, FL)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to… more
- Humana (Tallahassee, FL)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex to… more
- CVS Health (Tallahassee, FL)
- …resistant illnesses through peer review and educational interventions. * Work with medical director teams focusing on inpatient care management, clinical ... coverage review, member appeals clinical review, medical claim review, and provider appeals clinical review. * Actively participate in scheduled team… more
- Elevance Health (Miami, FL)
- **Clinical Operations Medical Director ** ** Medical Oncology** **Carelon Medical Benefit Management** **Virtual** : This role enables associates to work ... of clinical domains, including radiology, cardiology and oncology._ The **Clinical Operations Medical Director ** is responsible for supporting the medical … more