- 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
- Centene Corporation (Tallahassee, FL)
- …everything for our 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization ... Assist the Chief Medical Director to direct and coordinate the medical management , quality improvement and credentialing functions for the business unit.… more
- The Cigna Group (Fort Lauderdale, FL)
- …communication with matrix partners including but not limited to, Claims Operations, Medical Management . Credentialing, Legal, Medical Economics, Compliance, ... 3 days per week The **Manager, Provider Contracting Network Management ** serves as an integral member of the Provider...position. + Creates and manages initiatives that improve total medical cost and quality. + Drives change with external… more
- Molina Healthcare (FL)
- …provider reimbursement changes + Provide data driven analytics to Finance, Claims, Medical Management , Network, and other departments to enable critical decision ... projects related to medical cost reduction initiatives + Support Medical Management by assisting with Return on Investment (ROI) analyses for vendors to… more
- Molina Healthcare (FL)
- …provider reimbursement changes + Provide data driven analytics to Finance, Claims, Medical Management , Network, and other departments to enable critical decision ... to medical cost reduction initiatives and budgeting same + Support Medical Management by assisting with Return on Investment (ROI) analyses for vendors to… more
- Travelers Insurance Company (Tallahassee, FL)
- … capabilities to keep Travelers at the leading edge of the P&C industry. Develop medical management strategies that help injured employees return to work as soon ... **What Is the Opportunity?** Lead the strategy and operations of Travelers Claim Medical initiatives focusing on how developments in the broader medical … more
- Humana (Tallahassee, FL)
- …managed care industry including Medicare Advantage, Managed Medicaid, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health ... insurance, other healthcare providers. + Utilization management experience in a medical management review organization, such as Medicare Advantage and… more
- Highmark Health (Tallahassee, FL)
- …URAC, CMS, DOH, and DOL regulations, etc.). Ensure that all aspects of the medical management process are consistent with community standards of care. + ... care (hospital, outpatient, or private practice) **Preferred** + 1 year in Medical Management in a Health Insurance Plan; strong knowledge of managed care… more
- Elevance Health (Miami, FL)
- …**Clinical Operations Associate Medical Director** is responsible for supporting the medical management staff ensuring timely and consistent medical ... **Clinical Operations Associate Medical Director** **Interventional Pain** **Carelon Medical Benefits Management ** **Virtual:** This role enables associates… more
- CVS Health (Jacksonville, FL)
- …Neurosurgery, including post-graduate direct patient care experience specifically. Expands Aetna's medical management programs to address member needs across the ... continuum of care. Supports the Medical Management staff ensuring timely and consistent responses to members and providers. Leads all aspects of utilization… more