- CVS Health (Tallahassee, FL)
- …skills in a collaborative process to implement, coordinate, monitor and evaluate medical review cases. + Applies the appropriate clinical criteria/guideline and ... Years of clinical experience. + 1+ Year of Utilization Review Management and/or Medical Management experience. +...close on: 08/27/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with… 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 (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
- Humana (Tallahassee, FL)
- …will be a key enterprise leader, with responsibility for evolving Humana's Utilization Management of medical review by physician or nurse, with a focus on our 5+ ... 48 states. **Key Responsibilities** **:** + Lead an operational team of Medical Directors to review authorizations and ensure clinical decision-making skills… 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
- Merck (Tallahassee, FL)
- …Trial Planning, Communication, Decision Making, Empathy, Market Access, Medical Affairs, Medical Research, Medical Review , Medical Writing, Patient ... Skills & Experience:: + At least 5 years Global medical affairs experience with proven track record ...We will consider qualified applicants with arrest and conviction records for employment in compliance with the San Francisco… more