- Evolent (Tallahassee, FL)
- …Provides clinical rationale for standard and expedited appeals. + Utilizes medical/ clinical review guidelines and parameters to assure consistency in the MD ... and costly health conditions. Working across specialties and primary care , we seek to connect the pieces of fragmented... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Molina Healthcare (Tampa, FL)
- … Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, or ... Officer during Fair Hearings as may be required. + Serves as a clinical resource for Utilization Management, Chief Medical Officer, Physicians, and… more
- Molina Healthcare (Tampa, FL)
- …Experience Previous experience in Hospital Acute Care , ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / ... team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care , for… more
- CVS Health (Tallahassee, FL)
- …of utilization management services for assigned area + Implements clinical policies & procedures in accordance with applicable regulatory and accreditation ... with dedicated colleagues who are passionate about transforming health care . As the nation's leading health solutions company, we...Manager is accountable to support the day to day clinical and business operations of the team. This position… more
- HCA Healthcare (Ocala, FL)
- …monitor, and evaluate pharmacotherapy to ensure effective, safe, and economical patient care . Advanced Clinical Pharmacist will assist the Director of Pharmacy ... colleagues invested over 156,000 hours volunteering in our communities. As an Advanced Clinical Pharmacist with HCA Florida West Marion Hospital you can be a part… more
- HCA Healthcare (Gainesville, FL)
- …Eligibility for benefits may vary by location._** Come join our team as an Advanced Clinical Pharmacist Med Safety. We care for our community! Just last year, ... to caring for patients with purpose and integrity. We care like family! Jump-start your career as an Advanced...growth, we encourage you to apply for our Advanced Clinical Pharmacist Med Safety opening. We promptly review… more
- Fresenius Medical Center (Venice, FL)
- …or federal surveys. + Participates in the completion of the FMS Administrative Clinical Review . **PHYSICAL DEMANDS AND WORKING CONDITIONS:** + The physical ... all regulatory and FMS policy requirements. Ensure provision of quality patient care while maintaining cost-effective clinical operations in accordance with all… more
- University of Miami (Miami, FL)
- …preparedness, critical care , quality improvement, case management, risk management, utilization review , etc. Risk Management + Participate in relevant risk ... C hief will join a team of experienced clinicians and staff dedicated to leveraging clinical care and research to meet the needs of a diverse patient population.… more
- Humana (Tallahassee, FL)
- …to medical directors and leadership during Medicare and Medicaid LOB - Medicare Clinical Criteria Review (MCCR), Utilization Management Committee (UMC), ... societies + Please note this role will consist of working mostly independently to review at times large amount of clinical information to update clinical… more
- Highmark Health (Tallahassee, FL)
- …NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the ... job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the...or Public Health **EXPERIENCE** **Required** + 5 years in Clinical , Direct Patient care (hospital, outpatient, or… more