- Elevance Health (Miami, FL)
- **Medical Director- Medicare (Part-time)** Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... Candidates must be able to work Eastern Time Zone hours. The ** Medicare Medical Director** is responsible for the administration of physical and/or behavioral… more
- Humana (Tallahassee, FL)
- …of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Represents Humana at Administrative ... established clinical experience + Knowledge of the managed care industry including Medicare , Medicaid and or Commercial products + Must be passionate about… more
- Humana (Tallahassee, FL)
- …first** The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals. The Corporate Medical Director works on ... clinical experience + Knowledge of the managed care industry including Medicare , Medicaid and/or Commercial products + Must be passionate about contributing… more
- Molina Healthcare (Tampa, FL)
- …clinical pharmacy services (such as, therapeutic drug monitoring, drug regimen review , patient education, and medical staff interaction), and oversight (establishing ... and measuring performance metrics regarding patient outcomes, medications safety and medication use policies). **KNOWLEDGE/SKILLS/ABILITIES** + Handles and records inbound pharmacy calls from members, providers, and pharmacies to meet departmental, State… more
- Molina Healthcare (Tampa, FL)
- …unrestricted State Medical License, free of sanctions from Medicaid or Medicare . **Preferred Experience** * Peer Review , medical policy/procedure development, ... quality and financial goals across all LOBs * Responds to BH-related RFP sections and review BH portions of state contracts * Assist the BH MD lead trainers in the… more
- Humana (Tallahassee, FL)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or ... and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements, and will...daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, … more
- Humana (Tallahassee, FL)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or ... us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and reviewing home health, DME, skilled nursing facility and… more
- BAYADA Home Health Care (Orlando, FL)
- …while using the Medicare PDGM billing model and CMS guidelines. + Review and communicate OASIS edit recommendations to each clinician to promote OASIS accuracy. ... Utilization Review , Quality Assurance, Remote, Home Health Coding, Coder, Medicare **As an accredited, regulated, certified, and licensed home health care… more
- Humana (Tallahassee, FL)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or ... this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all… more
- Actalent (Sunrise, FL)
- …internal process development, and educates physicians and team members on utilization review issues. Ensuring smooth transitions and patient satisfaction is key to ... this role. Responsibilities + Review prior authorization requests for medical necessity and appropriateness...Milliman Commercial Guidelines + Medicaid + Medical management + Medicare + Managed care + Patient care + Medical… more