- 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
- CVS Health (Tallahassee, FL)
- …nurses use specific criteria to authorize procedures/ services or initiate a Medical Director referral as needed. + Assists management with training new ... + 3+ Years of clinical experience. + 1+ Year of Utilization Review Management and/or Medical Management experience. + Must have active and unrestricted RN… 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
- Actalent (Sunrise, FL)
- …+ Utilization management + InterQual + Milliman Commercial Guidelines + Medicaid + Medical management + Medicare + Managed care + Patient care + Medical ... of service authorization requests, ensuring the utilization of appropriate services . The UMN assists in complex cases, develops internal processes, and educates… 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
- Humana (Tallahassee, FL)
- …Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health ... other healthcare providers, clinical group practice management . + Utilization management experience in a medical management review organization,… more
- Humana (Tallahassee, FL)
- …industry including Medicare Advantage and Managed Medicaid products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health ... other healthcare providers, clinical group practice management + Utilization management experience in a medical management review organization,… more