• Family Health Advocate - Remote

    Sharecare (Tallahassee, FL)
    …open enrollment / new hire plan selection, claims issues, ID card issues, grievances/ appeals , utilization management (UM) status, including but not limited to ... 3rd parties for: + Claims adjustments + Grievances and appeals submissions + Utilization management intake or...Physical Therapy Assistant + Nursing Assistant + Medical Secretary/Clinic Manager + Radiology Technician + Home Health Aide +… more
    Sharecare (10/14/25)
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  • Medical Director, Behavioral Health (NE)

    Molina Healthcare (Miami, FL)
    …oversight and clinical leadership for health plan and/or market specific utilization management and care management behavioral health programs and chemical ... working closely with regional medical directors to standardize behavioral health utilization management policies and procedures to improve quality outcomes and… more
    Molina Healthcare (10/23/25)
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  • Medical Director

    Elevance Health (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 ... not required for posting. + Works independently with oversight from immediate manager . + May be responsible for an entire clinical program and/or independently… more
    Elevance Health (11/01/25)
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  • Plan Performance Medical Director- New York…

    Elevance Health (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 ... of managed care experience preferred. + Consulting experience preferred. + Utilization management experience preferred. + Master's Degree preferred. (MBA, MPH, etc.)… more
    Elevance Health (11/01/25)
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  • Managed Care Pharmacy Resident

    Elevance Health (Tampa, FL)
    …program, including Prior Authorizations, Medication Therapy Management (MTM), Lock-in, and Drug Utilization Review (DUR) programs. **How you will make an impact:** + ... monographs, and formulary recommendations. + Develop strategies to drive formulary utilization and optimization. + Collaborate with account management teams to… more
    Elevance Health (10/20/25)
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  • Medical Director

    Elevance Health (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 ... for posting. + Works independently with oversight from immediate manager . + May be responsible for an entire clinical...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
    Elevance Health (10/29/25)
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  • Associate Medical Director - Sleep Medicine

    Elevance Health (Miami, FL)
    …Medical Director** **Carelon Medical Benefits Management** **Radiology Benefit Management/ Utilization Review** **Virtual:** This role enables associates to work ... for services requested. + Makes medical necessity determinations for grievance and appeals appropriate for their specialty. + Ensures consistent use of medical… more
    Elevance Health (10/28/25)
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  • Plan Performance Medical Director

    Elevance Health (Tampa, 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 ... in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance Health location at least… more
    Elevance Health (10/25/25)
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  • Pharmacy Tech I

    Elevance Health (Pembroke Pines, FL)
    …of all prior authorization determinations. + Provides resolution to grievances and appeals issues. + Responds to inquiries from physicians, sales team, and members ... formulary and prescription benefits. + Generates reports relating to rebates, physician utilization , Beers Criteria, Reliance members, and other ad hoc reports. +… more
    Elevance Health (10/16/25)
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