- Evolent (Tallahassee, FL)
- …when available, within the regulatory timeframe of the request. + Utilizes medical/ clinical review guidelines and parameters to assure consistency in the ... you ready to make a meaningful impact on patient care in a non- clinical setting? Join our...to ensure the application of best practices. + Provides clinical rationale for standard and expedited appeals .… more
- Highmark Health (Tallahassee, FL)
- …to determine medical necessity and appropriateness. Complete initial determination of cases, review of appeals and grievances, and other reviews as assigned. ... DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of...or Public Health **EXPERIENCE** **Required** + 5 years in Clinical , Direct Patient care (hospital, outpatient, or… more
- Evolent (Tallahassee, FL)
- …of the request. + Provides clinical rationale for standard and expedited appeals . + Utilizes medical/ clinical review guidelines and parameters to assure ... and costly health conditions. Working across specialties and primary care , we seek to connect the pieces of fragmented...Director, MSK Surgery you will be a specialty match reviewer for Spine Surgery cases. you will be a… more
- Humana (Tallahassee, FL)
- …this knowledge in their daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, review of ... work, communication of decisions to internal associates, and possible participation in care management. The clinical scenarios predominantly arise from inpatient… more
- Evolent (Tallahassee, FL)
- …of the request and provides clinical rationale for standard and expedited appeals . + Utilizes medical/ clinical review guidelines and parameters to assure ... and costly health conditions. Working across specialties and primary care , we seek to connect the pieces of fragmented...to make a difference in patients lives, in a non- clinical environment. You can enjoy better work- life balance… more
- Evolent (Tallahassee, FL)
- …of the request and provides clinical rationale for standard and expedited appeals . . Utilizes medical/ clinical review guidelines and parameters to assure ... and costly health conditions. Working across specialties and primary care , we seek to connect the pieces of fragmented...to make a difference in patients lives, in a non- clinical environment. You can enjoy better work- life balance… more
- Evolent (Tallahassee, FL)
- …of the request and provides clinical rationale for standard and expedited appeals . + Utilizes medical/ clinical review guidelines and parameters to assure ... and costly health conditions. Working across specialties and primary care , we seek to connect the pieces of fragmented...to make a difference in patients lives, in a non- clinical environment. You can enjoy better work- life balance… more
- Evolent (Tallahassee, FL)
- …when available, within the regulatory timeframe of the request. + Utilizes medical/ clinical review guidelines and parameters to assure consistency in the ... and costly health conditions. Working across specialties and primary care , we seek to connect the pieces of fragmented...be completed by the subject matter expert. + Provides clinical rationale for standard and expedited appeals .… more
- AdventHealth (Tampa, FL)
- …Division . AdventHealth Tampa, a faith-based not-for-profit 626-bed tertiary-level acute care hospital located in the uptown district of Tampa, Florida, specializes ... Research Institute, also located at AdventHealth Tampa, leads the way in clinical and academic research in the areas of neuroscience, cardiovascular medicine,… more
- AdventHealth (Altamonte Springs, FL)
- …support of Utilization Management, the Physician Advisor is responsible for providing clinical review of utilization, claims management, and quality assurance ... value you will bring to the team:** + Provides clinical support/validation for both Utilization Management and Care...and grievances from patients; assists in drafting and submitting clinical denial appeals , as needed + Develops… more