- Humana (Tallahassee, FL)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members ... **Become a part of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement… more
- USAA (Tampa, FL)
- …part of what makes us so special! **The Opportunity** We are seeking a dedicated Claims Litigation Case Manager Senior. This position is a hybrid work type and can ... resource for colleagues with less experience. + Applies advanced knowledge of claims litigation processes. + Proactively manages litigation and acts as liaison with… more
- USAA (Tampa, FL)
- …and projects and reviewing work papers. May lead Bank Fraud Management , Dispute Operations, and general banking engagements involving fraud as Auditor-In-Charge ... issues, establish collaborative client relationships, and proactively work with client management to assess risk and improve internal controls. Adheres to the… more
- HCA Healthcare (Fort Lauderdale, FL)
- …coding. * Report and manage IET's and Claims on Hold, Encounters without Claims in conjunction with Practice management . * Regularly review A/R data and ... invested over 156,000 hours impacting our communities. As a Director of Revenue with HCA Healthcare, you can be...colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no… more
- AdventHealth (Ormond Beach, FL)
- …policies and procedures. The Director manages the Ambulatory Services Risk Management & Patient Safety Department and the Medical staff department. The ... knowledge of federal legislation, state statutes, and regulatory requirements relevant to risk management . Knowledge of claims management , general and… more
- AdventHealth (Maitland, FL)
- …Site position** **The role you'll contribute:** As the physician advisor, the Executive Medical Director of Revenue Cycle educates, informs, and advises members ... prevention measures for our contracted managed care payers. The Medical Director is responsible for providing physician... is responsible for providing physician review of utilization, claims management , and quality assurance related to… more
- Humana (Tallahassee, FL)
- … management or utilization management . **Additional Information** Reports to a Lead Medical Director . The Medical Director conducts Utilization ... a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews preauthorization requests… more
- Centene Corporation (Tallahassee, FL)
- …the Chief Medical Director to direct and coordinate the medical management , quality improvement and credentialing functions for the business unit. + ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a...performance improvement initiatives for capitated providers. + Assists Chief Medical Director in planning and establishing goals… more
- Humana (Tallahassee, FL)
- …us put health first** The Corporate Medical Director relies on medical background and reviews health claims and preservice appeals. The Corporate ... Medical Director works on problems of diverse scope and complexity...focused on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience, + working with… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …Remote Position Position Purpose: Responsible for the overall management of the medical division including medical management , case management , ... benefit/payment components. + Work collaboratively with quality improvement, member services, medical care management , provider relations and the executive team… more