- Molina Healthcare (FL)
- …national, state, and local laws and regulatory requirements affecting the medical and clinical staff. MD licenses required for the following states: WA, FL, MI, MS, ... includes strategies that ensure a high quality of patient care , ensuring that patients receive the most appropriate ...+ Participates in and maintains the integrity of the appeals process, both internally and externally. Responsible for the… more
- Centene Corporation (Tallahassee, FL)
- … care management teams to optimize outcomes. + Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants ... Assists in the development and implementation of physician education with respect to clinical issues and policies. + Identifies utilization review studies and… more
- Trinity Health (Fort Lauderdale, FL)
- …denial coordination with Patient Business Service (PBS) centers, including analysis of clinical documentation, assisting in appeals , root cause analysis and ... complete documentation to ensure revenue optimization and integrity. Perform outpatient clinical documentation improvement review (acute only) as needed. Perform… more
- Elevance Health (Tampa, FL)
- …as a resource and consultant to other areas of the company; particularly the Medical Review and Appeals areas + May be required to represent the company to ... May chair company committees. + Interprets medical policies and clinical guidelines. + May develop and propose new medical...or territory of the United States when conducting utilization review or an appeals consideration and cannot… more
- Elevance Health (Miami, FL)
- … clinical consultation and serve as clinical /strategic advisor to enhance clinical operations. May identify cost of care opportunities. May serve as a ... Leads develops, directs, and implements clinical and non- clinical activities that impact health care quality...or territory of the United States when conducting utilization review or an appeals consideration and cannot… more
- LogixHealth (Dania Beach, FL)
- …expert coding and billing services that allow physicians to focus on providing great clinical care . LogixHealth was founded in the 1990s by physicians to service ... up on unpaid claims + Prepare and submit out appeals on claims that require additional review ...services, we utilize proprietary software to provide valuable financial, clinical , and other data insights that directly improve the… more
- Highmark Health (Tallahassee, FL)
- …partners and stakeholders across the organization. Key responsibilities will include clinical review , assisting in navigating a complex regulatory environment, ... Formularies, utilization management programs, and disease management initiatives. + Provide clinical review and decisions including but not limited to:… more
- Evolent (Tallahassee, FL)
- …engagement to help ensure high value care delivery.** + Offer ** clinical rationale for standard and expedited appeals ,** ensuring compliance with UM ... We Offer:** + A unique opportunity to **impact patient care beyond direct clinical practice.** + A...+ **Computer proficiency** and ability to navigate electronic medical review platforms. + No current exclusions, sanctions, or disciplinary… more
- Ascension Health (Jacksonville, FL)
- …and opportunity. + Responsible for monitoring, measurement and quality improvement of clinical care utilizing evidence-based best practices to support, promote ... an advocate on behalf of our patients, physicians and clinical staff. Identifies, cultivates and develops emerging physician leaders,...Serves as physician advisor to assist with level of care , length of stay, denial management, appeals ,… more
- Prime Therapeutics (Tallahassee, FL)
- …for drug infusion services versus the hospital outpatient facility.Discusses financial and clinical considerations with members who are considering care at a ... these cases in web-based application and spreadsheets. + Supports clinical services such as the appeals program....+ Experience in managed care , specialty drugs, care management and utilization review . + Meets… more