- 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
- Humana (Tallahassee, FL)
- …group practice management + Utilization management experience in a medical management review organization such as Medicare Advantage, managed Medicaid, ... put health first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work… more
- CVS Health (Tallahassee, FL)
- …care of patients with severe, complex, and/or treatment resistant illnesses through peer review and educational interventions. * Work with medical director teams ... focusing on inpatient care management, clinical coverage review , member appeals clinical review , medical claim review , and provider appeals clinical … more
- Veterans Affairs, Veterans Health Administration (Pensacola, FL)
- …time and minimize associated travel reimbursement expenses. Works with Patient Travel and Accounting staff to ensure medical documentation is complete so ... Summary This Medical Support Assistant (MSA) position is in the...that authorized veterans receive appropriate travel pay. Referencing MISSION Act rules to determine if… more
- Fresenius Medical Center (Tampa, FL)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical operations. ... a tremendous asset that sets us apart. At Fresenius Medical Care, you will truly make a difference in...+ Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. +… more
- Humana (Tallahassee, FL)
- …focused on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience + Working with health ... The Corporate Medical Director (CMD) relies on medical background to review health claims and...10-hour workdays per week, either Friday-Monday or Thursday-Sunday schedule. Travel : While this is a remote position, occasional … more
- Fresenius Medical Center (Venice, FL)
- …communicated to and implemented by the facility staff. + Maintains integrity of medical records and other FMS administrative and operational records. + Complies with ... renal team. Communicates changes in patient status regarding clinical, insurance, travel and transportation issues to the disease management company. Maintains… more