- Highmark Health (Tallahassee, FL)
- …including, but not limited to: medical/surgical physician and institutional claims and encounters, clinical data , prescription drug data , membership data ... to design, develop, and support various complex projects and data analyses. A primary responsibility is to transform loose...in the resolution of issues or problems. + Access, review , utilize, contribute content to and participate in the… more
- Elevance Health (Tampa, FL)
- …case reviews with attending physicians or other ordering providers to discuss review determinations. + Interprets existing policies or clinical guidelines and ... which they are employed. **Preferred Skills, Capabilities and Experiences:** + Experience with clinical finance data , as well as medical cost and trend analysis.… more
- Humana (Tallahassee, FL)
- …the appropriate courses of action. The Appeals Nurse 2 reviews documentation and interprets data obtained from clinical records to apply appropriate clinical ... caring community and help us put health first** The Appeals Nurse 2 resolves clinical complaints and appeals. The Appeals Nurse 2 work assignments are varied and… more
- Oracle (Tallahassee, FL)
- **Job Description** The Oracle Clinical AI Agent team's mission is to deliver an AI platform that serves as the foundation for Oracle's health applications. By ... Our diverse team of innovators is building the future of conversational clinical interfaces-improving the lives of patients and providers worldwide. We work with… more
- Elevance Health (Tampa, FL)
- …required by law. The **Medical Director-Dermatology Appeals** is responsible for the review of appeals for physical health medical services, to ensure the ... and implementing programs to improve quality, cost, and outcomes. May provide clinical consultation and serve as clinical /strategic advisor to enhance … 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 ... to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The...is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical … more
- HCA Healthcare (Bradenton, FL)
- …how to reduce the variable cost per case while maintaining and enhancing clinical effectiveness. + Creates a data -driven environment of quality and cost ... Officer (CMO) ensures high quality, patient-centered care by leading clinical and quality initiatives that support the provision of...improvement and develops systems to review utilization of resources and objectively measure outcomes of… 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 ... moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Medical Director actively… more
- HCA Healthcare (Ocala, FL)
- …reach our goals. Unlock your potential! **Job Summary and Qualifications** ** Clinical Quality Review Specialist/Quality Assurance Coordinator: Responsible for ... Identifies opportunities for improvement during point of care record review and or during data abstraction. +...data and enters data into required data bases. + Serves as a clinical … more
- HCA Healthcare (Kissimmee, FL)
- …of staff in Performance improvement concepts and methods. + Facilitates use of data to identify opportunities to improve clinical outcomes, prevent events with ... and Medical Staff participates. + Collects, tabulates, and coordinates analysis of data related to required indicators. Prepares reports for hospital management and… more