- Molina Healthcare (St. Petersburg, FL)
- …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... + 3+ years relevant experience, including: + 2 years previous experience as a Medical Director in a clinical practice. + Current clinical knowledge. + Experience… more
- Humana (Tallahassee, FL)
- …care management, provider relations, quality of care, audit, grievance and appeal and policy review . The Behavioral Health Medical Director will develop and ... operations team and healthcare organization. The Medical Director 's work includes computer based review of...management + Utilization management experience in a medical management review organization, such as Medicare… more
- DOCTORS HEALTHCARE PLANS, INC. (Miami, FL)
- …are a plus. Experience: + Minimum 5-10 years of progressively responsible experience in medical management, or utilization review within a healthcare plan, ... Position Summary: The Director of Medical Management is responsible...for the strategic direction, leadership, and oversight of all medical management functions, including Utilization Management, and… more
- 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 ...management. + Utilization management experience in a medical management review organization, such as Medicare… more
- Evolent (Tallahassee, FL)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure...process. + On a requested basis, may function as Medical Director for selecting health plans or… more
- Humana (Tallahassee, FL)
- …part of our caring community and help us put health first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & ... and medical necessity. The Medical Director 's work includes computer based review of...management + Utilization management experience in a medical management review organization such as Medicare… more
- Evolent (Tallahassee, FL)
- …timely and accurate manner. . May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, ... the culture. **What You'll Be Doing:** As a Field Medical Director , Oncology, you will be a... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Evolent (Tallahassee, FL)
- …timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, ... the culture. **What You'll Be Doing:** As a Field Medical Director , MSK Surgery you will be... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Elevance Health (FL)
- ** Medical Director ** _Please note that per...state or territory of the United States when conducting utilization review or an appeals consideration and ... for employment, unless an accommodation is granted as required by law._ The ** Medical Director ** is responsible for the administration of physical and/or… more
- Elevance Health (Miami, FL)
- ** Medical Director ** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, ... we will drive the future of health care. The ** Medical Director ** is responsible for the administration...state or territory of the United States when conducting utilization review or an appeals consideration and… more