- CenterWell (Tallahassee, FL)
- …will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review ... Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to… more
- CenterWell (Tallahassee, FL)
- …will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review ... RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work… more
- Molina Healthcare (St. Petersburg, FL)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests additional information from members or providers in… more
- Molina Healthcare (Tampa, FL)
- …Experience Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests additional information from members or providers in… more
- Molina Healthcare (FL)
- …needed. + Processes requests within required timelines. + Refers appropriate cases to Medical Directors and presents them in a consistent and efficient manner. + ... promote Molina Care Model. + Adheres to UM policies and procedures. + Occasional travel to other Molina offices or hospitals as requested, may be required. This can… more
- Humana (Tallahassee, FL)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, ... to operationalize this knowledge in their daily work. The Medical Director's work includes computer-based review of...on size of region or line of business. The Medical Director conducts Utilization Management of the… more
- Humana (Tallahassee, FL)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, ... to operationalize this knowledge in their daily work. The Medical Director's work includes computer-based review of...on size of region or line of business. The Medical Director conducts Utilization Management of the… more
- Humana (Tallahassee, FL)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, ... Medical Director, depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an… more
- Humana (Tallahassee, FL)
- …clinical group practice management + Utilization management experience in a medical management review organization, such as Medicare Advantage and managed ... management, provider relations, quality of care, audit, grievance and appeal and policy review . The Behavioral Health Medical Director will develop and present… more
- Highmark Health (Tallahassee, FL)
- …NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the ... and improve the care of our members **ESSENTIAL RESPONSIBILITIES** + Conduct electronic review of escalated cases against medical policy criteria, which may… more