- Centene Corporation (Tallahassee, FL)
- …changes everything for our 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national ... Medical Director to direct and coordinate the medical management , quality improvement and credentialing functions... medical review of complex, controversial, or experimental medical services , ensuring timely and quality decision… 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
- 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
- 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
- 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...providers and facilities to support the effective execution of medical services programs by the clinical teams.… more
- Molina Healthcare (FL)
- …for strategic analysis, profitability, financial analysis, utilization patterns and medical management . + Interfaces and maintains positive interactions ... reporting service level benchmarks for EIM team. + Represents Medical Economics department in cross-departmental and operational meetings. + Serves as liaison… more
- University of Miami (Miami, FL)
- …+ Works closely with corporate and defense counsel, directors, corporate associates, and medical and allied health staff on risk management issues and concerns. ... and other regulatory agency reportable events and prepare submission for approval by Associate Medical Risk management Officer and the Chief Medical Risk… more
- Elevance Health (Miami, FL)
- …development. The ** Medical Director, Cardiology** is responsible for supporting the medical management staff ensuring timely and consistent medical ... physician calls to gather medical appropriate information in order to make medical necessity determinations for services requested. + Makes medical … more
- AdventHealth (Altamonte Springs, FL)
- … staff to optimize resource utilization, ultimately resulting in enhanced patient service , improved medical staff satisfaction, and reduced costs. Furthermore, ... Business acumen covering strategic planning, information systems utilization, financial management , budgeting, reimbursement, managed care, healthcare economics, medical… more