- Highmark Health (Tallahassee, FL)
- …Inc. **Job Description :** **JOB SUMMARY** This role supports the Medical Policy team by bringing medical director level expertise, experience and ... **ESSENTIAL RESPONSIBILITIES** + Full-cycle ownership of commercial and Medicare Advantage medical policy creation process including writing clinical criteria… more
- Elevance Health (FL)
- …decisions. + Brings to their supervisors attention, any case review decisions that require Medical Director review or policy interpretation. + Determine ... **Clinical Operations Medical Director ** **Carelon MBM** **Virtual:** This...which may include AIM Appropriateness Guidelines, client-specific health plan medical policy , well established evidenced based guidelines,… more
- Humana (Tallahassee, FL)
- **Become a part of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and ... health, SNF, DME, dual Medicare/Medicaid and Waiver requests. The Medical Director provides medical interpretation...communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee… more
- Humana (Tallahassee, FL)
- **Become a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The ... Medical Director work assignments involve moderately complex to complex issues...communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee… more
- Humana (Tallahassee, FL)
- **Become a part of our caring community and help us put health first** The Medical Director relies on fundamentals of CMS Medicare Guidance on following and ... health, SNF, DME, dual Medicare/Medicaid and Waiver requests. The Medical Director provides medical interpretation...communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee… more
- Humana (Tallahassee, FL)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of...communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee… more
- Humana (Tallahassee, FL)
- **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement ... to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of...communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee… more
- Humana (Tallahassee, FL)
- …Become a part of our caring community and help us put health first The Medical Director actively uses their medical background, experience, and judgement to ... to operationalize this knowledge in their daily work. The Medical Director 's work includes reviewing of all...communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee… more
- Humana (Tallahassee, FL)
- **Become a part of our caring community and help 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 involve moderately complex...value based care in accordance with Medicare and Humana policy . All work occurs within a context of regulatory… more
- Elevance Health (Miami, FL)
- …+ Brings to their supervisors attention, any case review decisions that require Medical Director review or policy interpretation. **Minimum Requirements:** + ... **Clinical Operations Medical Director ** ** Medical Oncology**...necessity of requests using guidelines and client-specific health plan medical policy . + Conduct peer-to-peer discussions with… more