- CVS Health (Tallahassee, FL)
- …with medical director teams focusing on inpatient care management, clinical coverage review , member appeals clinical review , medical claim review , ... Be present for regulatory audits in-person. * Support all Clinical Quality initiatives and peer review processes including Quality of Care and Quality of Service… more
- CVS Health (Tallahassee, FL)
- …Identify, research, analyze and document analytic leads or referrals to send for investigative review . + Review company clinical and payment policies to ... determine the impact of the scheme on Aetna business. + Keep current with new and emerging fraud, waste, and abuse schemes and trends through training sessions and industry resources. + Communicate with colleagues, verbally and in writing, findings related to… more
- Pfizer (Tampa, FL)
- …assigned clinical studies. + Provides therapy area/indication expertise in support of clinical review of clinical data - including CRF design, assistance ... and SCS + Support appropriate interpretation and communication of clinical trial data. + Review and approve submission level safety narrative plan. + Supports… 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 ... make a meaningful impact on patient care in a non- clinical setting? Join our Utilization Management team as a...MD review process to reflect appropriate utilization and compliance with… more
- CVS Health (Tallahassee, FL)
- …reporting to align local efforts with state and national quality goals. **Key Responsibilities** ** Clinical Review & Compliance** + Review and evaluate ... combines clinical expertise with quality improvement leadership, including clinical documentation review , Performance Improvement Projects (PIPs), ANE… 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 ... the culture. **What You'll Be Doing:** As a Physician Clinical Reviewer, Interventional Pain Management, you will be a...MD review process to reflect appropriate utilization and compliance with… more
- Evolent (Tallahassee, FL)
- …utilization management with collaborative engagement and innovation. **Core Responsibilities** + ** Clinical Review & Peer Collaboration** + Serve as the ... play a pivotal role in advancing value-based care models that prioritize clinical excellence, patient-centered outcomes, and system-wide impact. This role offers the… more
- Evolent (Tallahassee, FL)
- …provides clinical rationale for standard and expedited appeals. . Utilizes medical/ clinical review guidelines and parameters to assure consistency in the MD ... to make a difference in patients lives, in a non- clinical environment. You can enjoy better work- life balance... review process to reflect appropriate utilization and compliance with… more
- Evolent (Tallahassee, FL)
- …provides clinical rationale for standard and expedited appeals. + Utilizes medical/ clinical review guidelines and parameters to assure consistency in the MD ... to make a difference in patients lives, in a non- clinical environment. You can enjoy better work- life balance... review process to reflect appropriate utilization and compliance with… more
- CenterWell (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 ... and work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal… more