- Elevance Health (Miami, FL)
- ** Appeals Medical Director - Medicare ** **Location:** This role enables associates to work virtually full-time, with the exception of required in-person ... is granted as required by law. Alternate locations may be considered. The ** Appeals Medical Director ** is responsible for the appeal reviews for physical… more
- Elevance Health (Miami, FL)
- ** Medical Director - Florida Medicare ...the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... must reside in Florida near our Miami or Tampa locations.** The ** Medical Director ** will support the following Florida Medicare plans: Simply Healthcare… more
- Molina Healthcare (Miami, FL)
- …reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * ... JOB DESCRIPTION Job Summary Provides medical oversight and expertise in appropriateness and ...* Participates in and maintains the integrity of the appeals process, both internally and externally. * Responsible for… more
- Molina Healthcare (Miami, FL)
- …reviews behavioral health portions of state contracts. * Assists behavioral health medical director lead trainers in the development of enterprise-wide education ... JOB DESCRIPTION Job SummaryProvides medical oversight and expertise related to behavioral health...second level behavioral health clinical reviews, peer reviews and appeals . * Supports behavioral health committees for quality compliance.… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …reporting variances in utilization of resources, avoidable days/denials. Works in collaboration with Appeals Management/ Medical Director in the appeals ... for the requested level of care/patient status to the Medical Director . + Proactively identifies and resolves...accurately and in a timely manner. + Adheres to Medicare and Medicaid regulatory guidelines as it pertains to… more