- Molina Healthcare (Miami, FL)
- JOB DESCRIPTION **Job Summary** Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal ... years clinical nursing experience, including at least 1 year of utilization review , medical claims review , long-term services and supports (LTSS), claims… more
- Travelers Insurance Company (Tallahassee, FL)
- …influences which can impact claim outcomes. Organize and coordinate Travelers' medical review functions. This includes interpreting Federal and State ... regulations and medical guidelines to establish medical review policies. Works in close collaboration with the Claim leaders and in partnership with other … more
- Parexel (Tallahassee, FL)
- …protocol design and drug development programs + Support pharmacovigilance activities including medical review of serious adverse events + Provide risk ... + Review and approve critical study documents including protocols, Medical Monitoring Plans, safety reports, and Informed Consent Forms + Conduct real-time… more
- Parexel (Tallahassee, FL)
- …in high quality consultation on protocol development or drug development programs, medical review of various documents, collaboration on internal therapeutic ... Respect, Empowerment & Accountability. **Parexel is looking for a Medical Director with a very strong background in Ophthalmology...very strong background in Ophthalmology to join our Global Medical Sciences team.** **The role can be based remo**… more
- Evolent (Tallahassee, FL)
- …with a focus on **value-based strategy and transformation** . Unlike traditional medical review roles that emphasize volume throughput, this position integrates ... redefining how care is delivered for individuals facing cancer. As a Performance Suite Medical Director in Medical Oncology, you will play a pivotal role in… more
- MyFlorida (Tallahassee, FL)
- …filed in the State of Florida. Training is provided on relevant policy, medical review and vocational evaluation. Potential advancement based on successful ... OPS MEDICAL DISABILITY EXAMINER - 64858503 Date: Dec 19,...No: 867173 Agency: Department of Health Working Title: OPS MEDICAL DISABILITY EXAMINER - 64858503 Pay Plan: Temp Position… more
- Elevance Health (Miami, FL)
- …an impact:** + Perform physician-level case review , following initial nurse review , of Medical Oncology regimens and supportive care. + Perform ... physician-level case review , following initial nurse review , of chemotherapy regimens. + Determine medical ...nurse review , of chemotherapy regimens. + Determine medical necessity of requests using guidelines and client-specific health… more
- Globus Medical, Inc. (FL)
- …insurance carrier, etc. + Verify all patient information uploaded is accurate. + Review medical documents and patient information to ensure insurance criteria is ... NuVasive Clinical Services, a subsidiary of Globus Medical Inc., is a leading provider of intraoperative...support in the billing and collections function of the medical revenue cycle process. Prepare new charges, complete insurance… more
- Parexel (Tallahassee, FL)
- …content when contributors provide content that does not meet document needs. + Provide medical editing review of draft and final documents prepared by other ... management with preparation of resourcing estimates for potential new medical writing projects, or review request for...for potential new medical writing projects, or review request for proposal packages to determine content and… 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 , medical claim review , and provider appeals clinical … more