• Registered Nurse Peer Review Oppe/Fppe…

    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
    AdventHealth (08/08/25)
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  • Supervisor, Care Review (RN) Utilization…

    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
    Molina Healthcare (08/20/25)
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  • Behavioral Medical Director - Florida

    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
    Centene Corporation (09/04/25)
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  • Ops Medical Case Manager

    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
    MyFlorida (08/08/25)
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  • Initial Review Pharmacy Technician - Remote

    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
    Prime Therapeutics (09/04/25)
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  • Director, Medical Affairs Strategy…

    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
    Sumitomo Pharma (07/30/25)
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  • Quality Data Coordinator - Medical

    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
    BayCare Health System (08/03/25)
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  • Medical Director - Dsnp/MMP

    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
    CVS Health (09/04/25)
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  • Quality Data Coordinator - Medical

    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 (07/03/25)
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  • Quality Data Coord - Medical Records

    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
    BayCare Health System (06/18/25)
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