- Humana (Tallahassee, FL)
- …focused on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience, + working with health ... part of our caring community and help us put health first** The Corporate Medical Director relies on medical background and reviews health claims and preservice… more
- Carnival Cruise Line (Miami, FL)
- …The Manager also escalates high-risk cases, conducts care coordination and utilization reviews. Operationally, the role supports shipboard medical teams, ... for duty per International Maritime Health guidelines. + **Crew Medical Claims Management** + Review crew cases...+ Lead investigations into complaints or concerns regarding crew medical issues. + Conduct utilization reviews to… more
- Highmark Health (Tallahassee, FL)
- …The Senior Risk Compliance Analyst is responsible for monitoring and analyzing medical and utilization management activities to ensure compliance with internal ... insights and guidance to internal departments. The Analyst conducts audits of Medical Directors, Utilization Management (UM) and Case Management (CM) processes… more
- Stantec (San Antonio, FL)
- …client engagements that drive revenue growth - Apply effective Go/No-Go review processes and monitor compliance to ensure consistent decision-making and strategic ... maintained and monitored to inform business development strategies and optimize employee utilization rates Project Focus: - Meet or exceed the direct utilization… more
- CVS Health (Orlando, FL)
- …Social Worker (LCSW) **Preferred Qualifications** + Bilingual Spanish + Managed care/ utilization review experience + Case management and discharge planning ... Behavioral Health is a work from home field based role with up to 40% travel within Orange, Osceola, Seminole and Brevard counties. The BH CCM , is responsible for… more
- Carnival Cruise Line (Miami, FL)
- … medical cases. + Lead investigations into complaints or concerns regarding crew medical issues. + Conduct utilization reviews to assess medical necessity ... return-to-work planning. The Manager also escalates high-risk cases, conducts utilization reviews, and represents the company in arbitration when needed.… more
- MyFlorida (West Palm Beach, FL)
- …the Regional Program Supervisor (RPS) to ensure effective and efficient utilization of all assigned resources through monitoring, training, and quality improvement ... Plans staff workloads, workflows, deadlines, work objectives, and time utilization . Directs the work of employees to ensure maximum...may be eligible for leave under the Family and Medical Leave Act (FMLA), or if an employee may… more
- Sevita (FL)
- …documentation; maintain confidentiality and adherence to individual rights standards; review and respond accordingly to adverse action regulatory correspondence and ... protocol; manage timely incident reporting and response to higher-level incidents; review trends; work with state operations and quality improvement leadership to… more
- Fujifilm (Tallahassee, FL)
- …courses, and grant requests received by Fujifilm from industry societies, Academic Medical Centers, and other health-related organizations in the West and South ... received by the Fujifilm Endoscopy Division from industry societies, Academic Medical Centers, and other health-related organizations in the West and South-Central… more
- HCA Healthcare (St. Petersburg, FL)
- …HCA Healthcare. **This role will support 14 facilities in the West Florida Division, travel is required, must live in the surrounding Tampa and St. Petersburg, FL ... and retirement of our colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no cost or for a low… more
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