- CVS Health (Tallahassee, FL)
- … review , and appeal request. This position is primarily responsible for Utilization Management , including prior authorization and precertification as well as ... part of a centralized team that supports the Medical Management staff and may support other health plans as...concurrent review . Cases could focus on inpatient or outpatient, acute… more
- Adecco US, Inc. (Tampa, FL)
- …or hospital setting. **PREFERRED QUALIFICATIONS** : + Previous comprehensive care continuum management , utilization review or discharge planning experience. ... understanding of the cost consequences resulting from care delivery decisions through utilization of reports and systems such as Health Plan Benefits, utilization… more
- Elevance Health (Miami, FL)
- …**Carelon Medical Benefits Management ** **Post Acute Care Benefit Utilization Management ** **Schedule: 10:00-7:00 Central Time** **** **Virtual:** This ... Operations Associate Medical Director** is responsible for supporting the medical management staff ensuring timely and consistent medical decisions to members and… more
- Amgen (Orlando, FL)
- …+ Offer office education during the access process, including formulary coverage/ utilization management criteria, insurance forms & procedures, benefits ... through payer prior authorization to appeals/denials requirements and forms + Review patient-specific information in cases where the site has specifically requested… more
- Centene Corporation (Tallahassee, FL)
- …go/no-go decisions. + Ensure integration across claims, eligibility, provider, and utilization management systems. + Oversee data/reporting integration to ... for legal responses, including Payment Integrity and market communications. + Review and approve business solutions and implementation requirements for new business… more
- Prime Therapeutics (Tallahassee, FL)
- …with a health plan + Prior client-facing experience + Prior experience with utilization management + Strong MS Office skills, experience with databases and ... teams. + Triages clinical requests for existing and prospective opportunities for review and prioritization + Contribution and coordination of clinical team support… more
- Centene Corporation (Tallahassee, FL)
- …analysis, and/or ROI evaluation preferred. Familiarity with claims payment, utilization management , provider/vendor contracts, risk adjustment for government ... to leadership and/or customers + Manage multiple, variable tasks and data review processes with limited supervision within targeted timelines + Support the design,… more
- HCA Healthcare (Margate, FL)
- …opportunities, strategic planning, revenue and reimbursement enhancement, cost and utilization management , and improved operational department performance. ... encourage you to apply for our Assistant Controller opening. We promptly review all applications. Highly qualified candidates will be contacted for interviews.… more
- HCA Healthcare (Gainesville, FL)
- …monitor and improve the patient flow program effectiveness as it relates to utilization review , resource management , and discharge planning and care ... hospitalists & PCP's to address and resolve issues related to facility utilization and patient flow process and facilitate strong working relationship between… more
- Humana (Tallahassee, FL)
- …focused on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience, + working with health insurance ... of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Represents Humana at Administrative… more