- Elevance Health (Tampa, FL)
- …time zone hours.** The ** Medical Director ** will be responsible for utilization review case management for Commercial business in the New England (CT, ... ** Medical Director - Commercial** Location: This role...state or territory of the United States when conducting utilization review or an appeals consideration and… more
- Monte Nido (Miami, FL)
- …lives while providing the opportunity for people to realize their healthy selves. ** Utilization Review Clinician** **Monte Nido** **Remote - EST or CST hours** ... strategies to provide comprehensive care within an intimate home setting. The Utilization Review **Clinician** is responsible for conducting daily administrative… more
- Actalent (Sunrise, FL)
- …and appropriateness using standardized Review Criteria. + Coordinate with the Medical Director /Physicians for requests outside standard Review Criteria. ... complex cases, develops internal processes, and educates physicians on utilization review issues. The role involves managing...assigned caseload. + Serve as a liaison between the Medical Director , physicians, and office staff to… more
- Community Health Systems (Naples, FL)
- …of the UR Director /Manager the UR Nurse reviews all admissions for medical necessity, correct orders based on medical condition (inpt vs OBS). Facilitates ... on performance improvement of the UR KPI's. Ensures proper and accurate medical record documentation. **Essential Functions** + Reviews new admissions using 3rd… more
- Evolent (Tallahassee, FL)
- …new hires to educate and train on Utilization management system and Field Medical Director process, standards and resources. + Acts as assigned mentor as ... Stay for the culture. **What You'll Be Doing:** The Medical Director for MSK Surgery is a...Provides medical direction to the support services review process. Responsible for the quality of utilization… more
- Centene Corporation (Tallahassee, FL)
- … management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , ... perspective on workplace flexibility. **Position Purpose:** Assist the Chief Medical Director to direct and coordinate the... review studies and evaluates adverse trends in utilization of medical services, unusual provider practice… more
- AdventHealth (Altamonte Springs, FL)
- …assists in drafting and submitting clinical denial appeals, as needed + Develops Medical Director relationships with payors to have open communication and ... Management, the Physician Advisor is responsible for providing clinical review of utilization , claims management, and quality...+ Provides education and serves as a resource to Medical Staff colleagues regarding best practices, Utilization … more
- Evolent (Tallahassee, FL)
- …non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional ... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National...process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Humana (Tallahassee, FL)
- …how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer based review of moderately complex to complex ... management. + Utilization management experience in a medical management review organization, such as Medicare...on size of region or line of business. The Medical Director conducts Utilization Management… more
- Evolent (Tallahassee, FL)
- …per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, ... culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more