- 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 (Tampa, FL)
- …Access and Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/utilization review , and/or other utilization management ... + Must have valid driver's license with good driving record and be able to drive within applicable state...Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of InterQual /… 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
- Prime Therapeutics (Tallahassee, FL)
- …Expert within the organization. + Conducts Program Integrity Audits including outreach and review of medical records to audit authenticity of provider ... The Initial Review Pharmacy Technician plays a key role in medical and pharmacy management initiatives critical to the company achieving revenue goals and… 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
- CVS Health (Tallahassee, FL)
- …care of patients with severe, complex, and/or treatment resistant illnesses through peer review and educational interventions. * Work with medical director teams ... focusing on inpatient care management, clinical coverage review , member appeals clinical review , ...close on: 09/30/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with… more
- BayCare Health System (St. Petersburg, FL)
- …Data Coordinator will work onsite on a full-time basis. Responsibilities + 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
- BayCare Health System (FL)
- …Data Coordinator** will work remotely on a full-time basis. **Responsibilities** + 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… more
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