- Elevance Health (Miami, FL)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... **Behavioral Health Medical** **Director-Psychiatrist** ** Appeals ** **Location:** This role enables associates to work...Director Associates. + Works independently with oversight from immediate manager . + May be responsible for an entire clinical… more
- Molina Healthcare (Tampa, FL)
- …(such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services ... The Pharmacist, UM will be responsible for reviewing coverage determinations and appeals in a timely, compliant, and accurate manner. The Pharmacist, UM will… more
- Banner Health (FL)
- …make Banner Health the best place to work and receive care. As an Associate Manager of RN Denials Management, you will be an integral part of leadership within the ... in payer clinical denials. Collaborates with Care Coordination, physician, Utilization Review, and other internal/external departments to overturn and/or reduction… more
- Elevance Health (Port St. Lucie, FL)
- …chronic illnesses, co-morbidities, and/or disabilities, to ensure cost effective and efficient utilization of long-term services and supports. + At the direction of ... and may be involved in process improvement initiatives. + Submits utilization /authorization requests to utilization management with documentation supporting and… more
- Elevance Health (Miami, FL)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... **Pharmacist Program Manager ** **Hybrid 1:** This role requires associates to...education programs. + Assists in developing formularies. Performs drug utilization analyses. + Participates in and presents to Pharmacy… more
- Regeneron Pharmaceuticals (Tampa, FL)
- …highly challenging for HCPs and Patients. Payer Formularies and restrictive Utilization Management Criteria including: Prior Authorization Processes, Step Edits, ... Appeals , detailed Clinical Documentation, Peer to Peer reviews etc.,...support through the Reimbursement Management Team. The Field Reimbursement Manager is a critical front-line member of the Regeneron… more
- Molina Healthcare (Jacksonville, FL)
- …of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies to ensure ... most appropriate care at the most effective setting. *Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and under-… more
- Molina Healthcare (St. Petersburg, FL)
- …modification of payment decisions. + Serves as a clinical resource for utilization management, CMOs, physicians and member/provider inquiries/ appeals . + Provides ... (Team will work on set schedule) Looking for a RN with experience with appeals , claims review, and medical coding. **Job Summary** Provides support for medical claim… more
- Elevance Health (FL)
- …impacting Carelon Services businesses, including behavioral health, medical benefits utilization management, specialty care solutions, and care delivery companies. + ... preferred. + Expertise in legal and regulatory issues affecting utilization management activities, including prior authorization, medical necessity, clinical… more
- Elevance Health (Miami, FL)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... medical director provides clinical expertise in all aspects of utilization review and case management. Provides input on the...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more