PensacolaFLRecruiter
the smart solution for Pensacola jobs

Medical Director Care Management

Company: Blue Cross Blue Shield of Florida
Location: Pensacola
Posted on: May 16, 2019

Job Description:

Position can be based remotely from any Florida location Job duties include but are not limited to:* Perform all types of UM reviews, including but not limited to Pre-service, Post-service, Concurrent Review and Appeals* Discuss cases with physician providers (Peer to Peer)* Apply health plan review hierarchy to member contracts, medical policy, clinical guidelines and other approved resources to render timely decisions on medical necessity requests* Collaborate with Case Managers to provide support and guidance on cases needing physician assistance* Meet any established metrics (compliance and accreditation) related to UM review efficiency, timeliness, and quality of review* Participate in ongoing Inter-rater reliability (IRR) audits and any other health plan audits as necessary* As necessary, assist nurses and other staff in understanding the principles behind appropriate utilization review and interpretation and application of benefits and policies* Participate in the development and review of Medical and Pharmacy policies as assigned* Support the organization as a subject matter expert* Perform as lead Medical Director consultant for one sub-category of utilization management, such as commercial or Medicare medical policy* Perform other duties as assigned and needed by the organization Job Requirements:* Current unrestricted Florida medical license as a Doctor of Medicine or Doctor of Osteopathic Medicine or ability to obtain Florida Medical License* Board Certification by American Board of Medical Specialties* 3 years of clinical experience* Experience working in a dynamic, fast-paced environment* Experience working both independently and in a team environment* Exceptional verbal and written communication Preferred:* Physician reviewer or utilization management experience* Primary Care Specialty physician experience

Keywords: Blue Cross Blue Shield of Florida, Pensacola , Medical Director Care Management, Executive , Pensacola, Florida

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Executive Jobs


General Manager
Description: Hampton Inn Mobile I-65 at Airport Blvd 1028 West I-65 Service Road Mobile, Alabama, 36609 United States General Manager About McKibbon Hospitality From each thoughtful business partnership to the personal (more...)
Company: McKibbon Hospitality
Location: Mobile
Posted on: 05/19/2019

A220 Quality Manager (021819-220) - Mobile
Description: Airbus is an international pioneer in the aerospace industry. We are a leader in designing, manufacturing and delivering aerospace products, services and solutions to customers on a global scale. We aim (more...)
Company: Airbus Final Assembly Line
Location: Mobile
Posted on: 05/23/2019

Family Medicine GME Program Director Physician Job In Pensacola, FL (P
Description: A new residency program in Pensacola, FL is seeking applicants for Family Medicine Program Director to
Company: Hayman Daugherty Associates, Inc
Location: Pensacola
Posted on: 05/18/2019


RN Registered Nurse - Case Management
Description: We Are Hiring We are hiring for an RN Case Manager to work in our Case Management Department at Providence Hospital in Mobile, Alabama.--Schedule:PRN-Day ShiftWhy Join Providence Founded in 1854 by the (more...)
Company: Ascension
Location: Mobile
Posted on: 05/18/2019

Sales Representative / Account Manager / Customer Service
Description: Sales Professionals FlashBanc is seeking an energetic and sales-focused individual to join our National Team of Outside Sales Partners. If you enjoy meeting new people, supporting local businesses, and (more...)
Company: FlashBanc
Location: Mobile
Posted on: 05/22/2019

Assistant Store Manager- Pier 1 Imports
Description: Overview br Inside every Pier 1 Imports store are assistant store managers who bring our home furnishings brand to life with their talent, dedication, resourcefulness and creativity. As the leading (more...)
Company: Pier 1 Imports
Location: Pensacola
Posted on: 05/22/2019

Real Estate Portfolio Manager
Description: We Are Hiring Real Estate Portfolio Manager - Real Estate - Full-Time, Days - Sacred Heart 5110 Bayou - Pensacola, FLWhy Join Ascension Ascension is a faith-based healthcare organization dedicated to (more...)
Company: Ascension
Location: Pensacola
Posted on: 05/23/2019

RN - Case Management (ER)
Description: RN - Case Management ER We Are Hiring Sacred Heart is looking for an experienced RN- Case Manager to join our ER team. Full time - 36 hours/week Why Join Ascension Thank you for your interest in Northwest (more...)
Company: Ascension
Location: Pensacola
Posted on: 05/20/2019

Energy Project Manager
Description: Ecology and Environment, Inc. is seeking an Energy Project Manager. This is a national position that can work from any location within the domestic U.S. experience in the Gulf Coast Region a plus. This (more...)
Company: Ecology and Environment
Location: Pensacola
Posted on: 05/19/2019

Manager - Physician Practice
Description: We Are Hiring Manager-Physician Practice Ops - FP Snow Road - Full-Time,Day - FP Snow Road - Mobile,ALWhy Join Ascension Thank you for your interest in Providence Hospital and its affiliated physician (more...)
Company: Ascension
Location: Mobile
Posted on: 05/20/2019

Log In or Create An Account

Get the latest Florida jobs by following @recnetFL on Twitter!

Pensacola RSS job feeds