- Highmark Health (Tallahassee, FL)
- …NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the ... **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most… more
- CenterWell (Tallahassee, FL)
- …Director of Physician Strategy at Utilization Management. The Medical Director conducts Utilization review of the care received by members in an assigned ... 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)
- …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
- 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 ... clinical reviews with attending physicians or other providers to discuss review determinations. + May conduct peer-to-peer clinical appeal case reviews with… 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
- Southland Holdings (Lake Worth, FL)
- …to increase productivity + Review projects to focus on equipment and manpower; review job costs and equipment utilization reports. Plan and review ... Estimators and Superintendents. + Check equipment to monitor for repairs, utilization , abuse or neglect. + Participate in safety-related training programs to… more
- Elevance Health (Tampa, FL)
- …regarding case and determines appropriate area to refer or assign case ( utilization management, case management, QI, Med Review ). + Provides information ... reports and documents all actions. + Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical… 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