- Elevance Health (Miami, FL)
- ** Medical Management Nurse** **Location:** Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training ... 7am - 6pm EST and will include weekends. The ** Medical Management Nurse** will be responsible for...member's clinical presentation to determine whether to approve requested service (s) as medically necessary. Works with healthcare providers to… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- … requests. + Reviews cases referred by the prior-authorization non-clinical medical management coordinator and pre-certification technician staff according to ... Position Is Not Remote Position Purposes: Evaluates and approves requested services using organizational policies or MCG(R) screening criteria. Responsibilities: +… more
- Elevance Health (Tampa, FL)
- …plans for people enrolled in Medicaid and/or Medicare programs in Florida. ** Medical Management Clinician Associate** **Location:** The candidate must reside in ... must be flexible for weekend coverage as needed. The ** Medical Management Clinician Associate** is responsible for...may include but are not limited to: + Confirms medical services are appropriate based on assigned… more
- Cleveland Clinic (Weston, FL)
- …Program OR military training as a Hospital Corpsman (HM), Combat Medic (68W) or Medical Service Technician (4N0X1) + Completion of a clinical externship OR ... department is directed by anesthesiologists who are board-certified in pain management . As a Medical Assistant on this team, you will collaborate with fellow… more
- Select Medical (Miami, FL)
- …significant PI findings pertaining to adverse drug reactions, drug usage evaluation, medical management of acute transfers and other CQI indicators. ... **Location: Miami, FL** **$10,000 Sign-on Bonus** **Director of Quality Management ** **(DQM)** **Responsibilities** **Position Summary** Coordinates the Medical … more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …information to providers. + Determine whether authorizations are required for requested medical services . + Reference tools to research relevant rules, ... Responsibilities: + Point of contact for providers regarding medical /behavioral/clinical services or benefits. Including (e-g notification, authorization). +… more
- Select Medical (Gainesville, FL)
- …therapist or master's in social work and minimum three (3) years of medical case management or similar experience._** **Previous case mangement ( discharge ... in order to ensure proper reimbursement for hospital provided services and to promote cost attentive care via a...a related discipline. + Minimum three (3) years of medical case management or similar experience. +… more
- CVS Health (Tallahassee, FL)
- …services . Promotes communication, both internally and externally to enhance effectiveness of medical management services (eg, health care providers, and ... Associate you will be supporting comprehensive coordination of medical services including Care Team intake, screening...clinical staff Identifies triggers for referral into Aetna's Case Management , Disease Management , Mixed Services ,… more
- Veterans Affairs, Veterans Health Administration (Miami, FL)
- …significant restriction on moonlighting Duties include but are not limited to: Provide medical management of patients who are rendered unconscious or insensible ... Summary The Miami VA Healthcare System's Anesthesiology Service is seeking an experienced and dynamic Physician... is seeking an experienced and dynamic Physician (Pain Management Anesthesiology). Ideal applicants are those who want to… 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. + ... outpatient, or private practice) **Preferred** + 1 year in Medical Management in a Health Insurance Plan;...**Preferred** + None **SKILLS** + Critical Thinking + Case Management + Customer Service + Oral &… more