- Molina Healthcare (Tampa, FL)
- …BH peer reviews and appeals * Supports BH committees for quality compliance . * Implements clinical practice guidelines and medical necessity review criteria * ... Tracks all clinical programs for BH quality compliance with NCQA and CMS * Assists with the...EXPERIENCE:** * 2 years previous experience as a Medical Director in clinical practice * 3 years' experience in… more
- Evolent (Tallahassee, FL)
- …the culture. **What You'll Be Doing:** Evolent is seeking an **Associate Medical Director - Cardiovascular Medicine** to play a critical role in **Performance Suite ... + Offer **clinical rationale for standard and expedited appeals,** ensuring compliance with UM policies and regulatory requirements. + Collaborate with… more