- Molina Healthcare (St. Petersburg, FL)
- …state/federal guidelines, billing and coding regulations, and Molina policies; validates the medical record and claim submitted support correct coding to ensure ... DESCRIPTION** **Job Summary** Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate… more
- CVS Health (Tallahassee, FL)
- …legal, compliance, or rework projects. + Ensure staff provide detailed written summaries of medical record review findings and ensure the team articulates ... in determining correct coding and appropriate documentation during the review of medical records . This...+ A minimum of 5 years of experience in medical record review for coding… more
- AdventHealth (Ocala, FL)
- …the analysis of events that require peer review and the examination of medical records as identified by clinical indicators or triggers is an integral part ... The Coordinator Professional Practice Evaluation is responsible for facilitating the medical staff Peer Review , Ongoing Professional Practice Evaluation (OPPE)… more
- Molina Healthcare (FL)
- …Access and Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/utilization review , and/or other utilization management ... CA, NV, IL, and MI + Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation.… more
- Pfizer (Tampa, FL)
- …data + Serves as needed as a Medical Affairs reviewer for MRC ( Medical Review Committee) + Supports data generation/analyses, ensures medical and ... medical information and relevant internal colleagues to enhance and deliver upon US medical plan(s). + Participate and support the review of promotional and… more
- Elevance Health (Tampa, FL)
- …+ Serves as a resource and consultant to other areas of the company; particularly the Medical Review and Appeals areas + May be required to represent the company ... ** Medical Director- Medicare Fee for Service** Location: This...fee for service and assisting nurses as needed with review of claims. Works with other Medicare Administrative Contractor… more
- Centene Corporation (Tallahassee, FL)
- …management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , quality ... review of complex, controversial, or experimental medical services, ensuring timely and quality decision making. +...by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA… more
- MyFlorida (Daytona Beach, FL)
- …Care recommendation, Significant Additional Needs requests, Skilled Nursing Exception Letters, medical review and Incident Management System reporting for ... Knowledge, Skills, And Abilities Knowledge of: + Case management and medical record reviews. + Individuals with development/intellectual disabilities preferred.… more
- Sumitomo Pharma (Tallahassee, FL)
- …Initiated Study and Collaborative Research program. + Provide detailed and compliant medical review and approval of external resources, communications, and ... as appropriate. + Capable of translating brand goals and objectives into actionable medical and scientific strategies. + Proven track record of detailed,… more
- BayCare Health System (Tampa, FL)
- …+ The Quality Data Coordinator - Medical Records coordinates medical record review with a multi-disciplinary team and distributes results ... for recommendations/actions. + Responsible to ensure quality of medical record health information by verifying the accuracy, consistency, and timeliness +… more