- Centene Corporation (Tallahassee, FL)
- …health clinicians preferred. Behavioral health clinical knowledge and ability to review and/or assess ABA Treatment Plans required. Knowledge of ABA services ... and BH utilization review process required. Experience working with providers and healthcare...required. Experience working with providers and healthcare teams to review care services related to Applied Behavior Analysis Services… more
- CVS Health (Tallahassee, FL)
- …a collaborative process to implement, coordinate, monitor and evaluate medical review cases. + Applies the appropriate clinical criteria/guideline and plan language ... thinking, evidenced based clinical criteria and clinical practice guidelines. Med Review nurses use specific criteria to authorize procedures/services or initiate a… more
- American Express (Sunrise, FL)
- …launch more than 28,000 marketing campaigns worldwide. The Communications Compliance Review (CCR) team within ECMX is responsible for consulting with marketing ... databases and Digital Asset Managers, creative development committees, creative review processes, operational controls and projects to update marketing content… more
- UMB Bank (Tallahassee, FL)
- …under normal and stressed scenarios. Within Credit Administration, the **Appraisal Review ** team supports Commercial, Small Business and Consumer Lending. As a ... Senior Commercial Review Appraiser, you will ensure compliance with the valuation...validations of commercial real estate properties. + You will review and validate appraisals of complex and higher-risk commercial… more
- Molina Healthcare (South Florida, FL)
- …field, such as social work or clinical counselor (for Behavioral Health Care Review Clinicians only). **Required Experience** 1-3 years of hospital or medical clinic ... in good standing, such as LCSW, LPCC or LMFT (for Behavioral Health Care Review Clinicians only). Must be able to travel within applicable state or locality with… more
- Centene Corporation (Tallahassee, FL)
- …criteria + Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care + ... care to members + Provides feedback on opportunities to improve the authorization review process for members + Performs other duties as assigned + Complies with… more
- MyFlorida (Tallahassee, FL)
- OPS OPERATIONS REVIEW SPECIALIST - 64858552 1 1 1 Date: Aug 23, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify ... . Requisition No: 854107 Agency: Department of Health Working Title: OPS OPERATIONS REVIEW SPECIALIST - 64858552 1 1 1 Pay Plan: Temp Position Number: 64858552… more
- Molina Healthcare (Tampa, FL)
- …team responsible for prior authorizations, inpatient/outpatient medical necessity/utilization review , and/or other utilization management activities aimed at ... experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of InterQual / MCG guidelines. **Preferred… more
- American Express (Sunrise, FL)
- …identity theft, and other financial crimes. The GFCSU's Quality Control Review (QCR) Team performs ongoing monitoring of Anti-Money Laundering (AML) investigations ... if a material or non-material error is identified. + Close all cases after review is completed. This includes correcting any errors prior to submission for closure… more
- Molina Healthcare (Miami, FL)
- …Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines. To all ... current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE)… more