- Humana (Tallahassee, FL)
- …topics to the clinical operations team and healthcare organization. The Medical Director 's work includes computer based review of moderately complex to ... and help us put health first** The Behavioral Health Medical Director is responsible for behavioral health...conferences, and other sources of expertise. The Behavioral Health Medical Directors will learn Medicare , Medicare… more
- Humana (Tallahassee, FL)
- **Become a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The ... Medical Director work assignments involve moderately complex to complex issues...materials, internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and … more
- Elevance Health (Tampa, FL)
- ** Medical Director - Medicare Fee...external committees. + May chair company committees. + Interprets medical policies and clinical guidelines. + May ... and Medicaid Services to transform federal health programs. The ** Medical Director ** is responsible for drafting and...as needed with review of claims. Works with other Medicare Administrative Contractor (MAC) Medical Directors for… more
- Humana (Tallahassee, FL)
- …a part of our caring community and help us put health first** The Corporate Medical Director (CMD) relies on medical background to review health claims ... and preservice appeals. The Corporate Medical Director works on problems of diverse...represents Humana at Administrative Law Judge hearings; exercises independent clinical judgment and decision making on complex issues regarding… more
- Humana (Tallahassee, FL)
- …a 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 appeals. The Corporate Medical Director works on problems of diverse...+ Excellent communication skills + 5 years of established clinical experience + Knowledge of the managed care industry… more
- Molina Healthcare (Jacksonville, FL)
- …and responding timely to claim disputes. Team consists of clinical and non- clinical staff. * Establishes Medicare Contracted Provider Post Pay dispute and ... Summary** Responsible for leading, organizing and directing the activities of the Medicare Contracted Provider Post-Pay Claim Appeals and Disputes in accordance with… more
- Molina Healthcare (Orlando, FL)
- …3+ years HMO/Managed Care experience **OR** 5 years experience as a Molina Medical Director + Demonstrated experience in Utilization/Quality Program management + ... Summary** Responsible for serving as the primary liaison between administration and medical staff. Assures the ongoing development and implementation of policies and… more
- CVS Health (Tallahassee, FL)
- …/ Appeal Hearings / Special Projects and Committee participation when needed. The Medical Director will provide clinical , coding, and reimbursement expertise ... / Pediatrics (Med / Peds) Board Certification. In the Medical Director role, you will provide oversight...directing case management when necessary. The Medical Director will act as a business and clinical… more
- ChenMed (St. Petersburg, FL)
- …transitional position towards becoming a center clinical P&L leader (ie, Senior Medical Director [SMD]) in the organization. The incumbent Center Medical ... simultaneously completing PCP Black Belt Training and Mastering the Medical Director Essentials within a combined and...CAHPS and net promoter score (patient experience), HEDIS and clinical gaps closures, and medical cost effectiveness… more
- Aveanna Healthcare (Tampa, FL)
- RN Clinical Director ApplyRefer a FriendBack Job Details Requisition #: 204579 Location: Tampa, FL 33607 Category: Nursing Salary: $78,000.00 - $82,000.00 per ... year Position Details Position: Clinical Director (RN) ( Director of...children, adolescents, and/or adults. Note: As an employer receiving Medicare and Medicaid funds, Aveanna employees must comply with… more