- Humana (Tallahassee, FL)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members ... caring community and help us put health first** The Medical Director relies on medical ...insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management… 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 to ... to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all...Delivery Systems, health insurance, or other healthcare providers. + Utilization management experience in a medical management… more
- Elevance Health (Tampa, FL)
- ** Medical Director - Florida Medicare Plans** Location: This role enables associates to work virtually full-time, with the exception of required in-person ... in Florida near our Miami or Tampa locations.** The ** Medical Director ** will support the following Florida...for clinical operational aspects of a program. + Perform utilization management reviews to determine medical necessity… more
- CVS Health (Tallahassee, FL)
- …resistant illnesses through peer review and educational interventions. * Work with medical director teams focusing on inpatient care management, clinical ... outcomes. * Leverage extensive knowledge of health care delivery system, utilization management, reimbursement methods and treatment protocols for DSNP/MMP and other… more
- Molina Healthcare (Tampa, FL)
- …the most appropriate care at the most effective setting. *Evaluates effectiveness of utilization management ( UM ) practices - actively monitoring for over and ... utilization . * Educates and interacts with network, group providers and medical managers regarding utilization practices, guideline usage, pharmacy … more
- Evolent (Tallahassee, FL)
- …Tasks are performed within the **RN/LVN/LPN** scope of practice, under the Medical Director 's direction, using independent nursing judgement and decision-making, ... identifies and refers cases that do not meet established clinical criteria to the Medical Director . + Appropriately identifies and refers quality issues to UM… more