- Elevance Health (Tampa, FL)
- …more complex situations. + May be assigned to work special projects relevant to medical call or general medical management policies, practices and procedures ... **Nurse Demand Management ** **Sign On Bonus:$3,000** Carelon Health is a...resources and nursing background to provide callers with appropriate medical information. + Provides caller with appropriate community resources… more
- Evolent (Tallahassee, FL)
- …for utilization management while working in conjunction with the Senior Medical Director. May assist the Senior Medical Director in research ... Be Doing:** As a Physician Clinical Reviewer, Interventional Pain Management , you will be a key member of the...reviewing cases that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests… more
- Humana (Tallahassee, FL)
- …Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health ... providers, clinical group practice management . + Utilization management experience in a medical management.... + Utilization management experience in a medical management review organization, such as Medicare… more
- Elevance Health (Miami, FL)
- …people we serve. The medical director supports product strategy/design through medical management that impact health care quality, cost, and outcomes, and ... Director** is responsible for serving as the Operational Medical Director for our care management models for our National Account clients. The medical… more
- Humana (Tallahassee, FL)
- …industry including Medicare Advantage and Managed Medicaid products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health ... providers, clinical group practice management + Utilization management experience in a medical management review organization, such as Medicare Advantage… more
- AdventHealth (Altamonte Springs, FL)
- …matter expert, providing clinical expertise and business direction in support of medical management programs, promoting the delivery of high quality, patient ... Management teams + Provides education and serves as a resource to Medical Staff colleagues regarding best practices, Utilization Management and Care … more
- Humana (Tallahassee, FL)
- …Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health ... providers, clinical group practice management . + Utilization management experience in a medical management.... + Utilization management experience in a medical management review organization, such as Medicare… more
- CVS Health (Tallahassee, FL)
- …Holding, Inc. (AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We provide flexible, cost-effective ... care management solutions that promote high-quality healthcare for members. We...Use established guidelines to authorize services or escalate to Medical Directors as needed. + Navigate multiple computer systems… more
- CVS Health (Tallahassee, FL)
- …member meetings as needed. * Develop and guide the implementation of Medical Management programs to ensure providers deliver appropriate, high-quality, ... resistant illnesses through peer review and educational interventions. * Work with medical director teams focusing on inpatient care management , clinical… more
- AdventHealth (Tampa, FL)
- …matter expert, providing clinical expertise and business direction in support of medical management programs, promoting the delivery of high quality, patient ... Care Management teams Provides education and serves as a resource to Medical Staff colleagues regarding best practices, Utilization Management and Care … more