- University of Miami (Miami, FL)
- …internal departments to facilitate patient flow. + Monitors staff productivity and quality of work through proactive review of key performance indicators. ... based call center operations to proficiently support all Front-End Revenue Cycle and Clinical Support remote functions. This list of duties and responsibilities… more
- Humana (Tallahassee, FL)
- …team and healthcare organization. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, review ... and work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, Medicaid state contracts, clinical … more
- Centene Corporation (Tallahassee, FL)
- …provider practice patterns, and adequacy of benefit/payment components. + Identifies clinical quality improvement studies to assist in reducing unwarranted ... leadership of all for utilization management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining… 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 ... and work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal… more
- Monte Nido (Miami, FL)
- …MN Provider Handbook. ** Quality Improvement & Compliance** + Engage in quality improvement initiatives and regularly review psychiatric and medical policies ... to realize their healthy selves. **Vice President of Psychiatry** **Monte Nido** **Full-Time/ Remote ** Monte Nido (MNA) is a national leader in eating disorder… more
- Humana (Tallahassee, FL)
- …their daily work specifically for DSNP. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review ... and work is assisted by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical reference materials,… more
- CVS Health (Tallahassee, FL)
- …criteria to evaluate outpatient and inpatient services requiring precertification and concurrent review . + Conduct clinical reviews via phone and electronic ... experience in a managed care organization (MCO). + Experience in a high-volume clinical call center or prior remote work environment. **Education** + Associate's… more
- Fujifilm (Tallahassee, FL)
- …Manager is to understand and define our internal and external endoscopic customers' clinical needs and assist with the development and implementation of clinical ... and education solutions. Additionally, this role builds and nurtures relationships with clinical customers as it relates to participating in clinical studies… more
- CVS Health (Jacksonville, FL)
- …to members and providers. Leads all aspects of utilization review / quality assurance, directing case management Provides clinical expertise and business ... transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health...effective use of health care resources. **This is a remote based (work at home) based anywhere in the… more
- Sumitomo Pharma (Tallahassee, FL)
- …Characteristics (SmPC), and Canadian Product Monograph (PM) + Ensures timely and quality review and assessment of ICSRs, including seriousness, expectedness, ... products. + Conduct safety surveillance over product life cycle, reviewing clinical trial and post-marketing Individual Case Safety Reports (ICSRs), including… more