- Evolent (Tallahassee, FL)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... the mission. Stay for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to make a… more
- Actalent (Sunrise, FL)
- …+ Prepare and present reports on department activities as assigned. Essential Skills + Clinical review + Utilization review + Utilization management + ... or LPN License. + Minimum of one year of utilization review experience and discharge planning in...involving shadowing a team member on-site on Tuesdays and remote shadowing via Teams. Pay and Benefits The pay… more
- ChenMed (Miami, FL)
- …experience in Hospital medicine preferred + At least one (1) year of utilization review experience preferred We're ChenMed and we're transforming healthcare for ... our team. The Physician Reviewer is the primary physician reviewer for Utilization Management/Clinical Appropriateness review cases in our organization. Other… more
- Prime Therapeutics (Tallahassee, FL)
- …make. **Job Posting Title** Pharmacy Trade Relations Strategy Director - remote **Job Description** The Pharmaceutical Trade Relations Strategy Director facilitates ... key internal stakeholders including Clinical, Clinical Program Management, and Utilization Management to deliver financial opportunities to Prime's clients.… more
- Molina Healthcare (St. Petersburg, FL)
- …Molina Healthcare is hiring for several Pharmacy Technicians. These roles are 100% Remote and require you be licensed either State or Nationally. These positions ... those involved in formulary management (such as, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services (such… more
- Merck (Tallahassee, FL)
- …support, educational or risk management) to support appropriate and safe utilization of Our Company medicines or vaccines. **Required Qualifications, Skills & ... days may vary by site or organization, with Friday designated as a remote -working day, unless business critical tasks require an on-site presence.This Hybrid work… 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 ... **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most… more
- Molina Healthcare (Miami, FL)
- …abuse through the identification of aberrant coding and/or billing patterns through utilization review . + Prepares appropriate FWA referrals to regulatory ... and abuse. Duties include performing accurate and reliable medical review audits that may also include coding and billing...providers when overpayments are identified. + Works may be remote , in office, and on-site travel within the state… more
- ICF (Tallahassee, FL)
- …risks and reduce future losses in its communities. **This position is 100% Remote in the United States.** ICF seeks an experienced professional to support mitigation ... understanding of all applicable Program policies, requirements, and procedures and review all cases within established program guidelines. + Approve and confirm… more
- Cognizant (Tallahassee, FL)
- …guidelines and regulations. * Experience in the analysis and processing of claims, utilization review /quality assurance procedures. * Must be able to work with ... flexibility wherever possible. Based on this role's business requirements, this is a remote position open to qualified applicants in the United States. Regardless of… more