- CVS Health (Tallahassee, FL)
- …outcomes. * Leverage extensive knowledge of health care delivery system, utilization management, reimbursement methods and treatment protocols for DSNP/MMP and other ... Health, Pharmacy, Member Outreach, Care Management, National Quality Management, Utilization Management, Compliance, and other departments to integrate social,… more
- Carnival Cruise Line (Miami, FL)
- …Manager also escalates high-risk cases, conducts care coordination and utilization reviews. Operationally, the role supports shipboard medical teams, participates ... crew members. **Essential Functions:** + **Case Management Oversight** + Manage and review cases, including those at domicile or regional centers of excellence. +… more
- Humana (Tallahassee, FL)
- …health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review ... this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all… more
- Humana (Tallahassee, FL)
- …Delivery Systems, health insurance, or clinical group practice management + Utilization management experience in a medical management review organization ... us put health first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work assignments… more
- Carnival Cruise Line (Miami, FL)
- …return-to-work planning. The Manager also escalates high-risk cases, conducts utilization reviews, and represents the company in arbitration when needed. ... Communicate with seafarers and their families with professionalism and empathy. + Review clinical care plans for appropriateness and support the case management team… more
- Oracle (Tallahassee, FL)
- …are achieved, maintenances are performed with minimal risk, manage capacity utilization , address local maintenance requirements, and support technical projects. The ... responsibilities include change management, incident & event support, space utilization , efficiency upgrades, and general engineering support. Directors are expected… more
- MyFlorida (Lake City, FL)
- …and procurement documents. Oversee the coordination and schedule of Technical Review Committee meetings, Selection Committee meetings, scope of services meetings, ... existing procurement policies/procedures. Coordinate the implementation of quality assurance review recommendations to existing processes, as applicable. Serve as… more
- Molina Healthcare (FL)
- …rate tracking and supplemental data impact reporting. + Develop Medical Record Review project reporting to track progress and team productivity reporting. + ... and other statistical methodologies to predict future trends in cost, utilization , and performance. + Assist with research, development and completion of… more
- Cleveland Clinic (Coral Springs, FL)
- …required, as needed.** A caregiver who excels in this role will: + Review daily assignments and ascertain surgeon-specific preferences and anesthesia. + Identify and ... follow-through. + Demonstrate prudence in par level supplies and utilization . + Serve as a resource individual for a...decreased turnover time per CPT and scheduled procedural time review . + Assure that all instrumentation is returned to… more
- Molina Healthcare (Tampa, FL)
- …analysts on software applications, business domain and design standards. *Conducts peer review of other analysts (internal and contract staff) to ensure standards ... Years of experience in Analysis related to HEDIS rate tracking, Medical Record Review tracking, Interventions tracking for at least one line of business among… more