- Taiho Oncology (FL)
- …you to join us. Territory Coverage: FL, GA, MS, PR, AL Formally known as Medical Science Liaison Position Summary: The Sr. Manager, Medical Field is a ... disease states, and facilitation of clinical research. The Sr. Manager, Medical Field integrates clinical/scientific expertise and knowledge to ensure successful… more
- 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 ... 3+ Years of clinical experience. + 1+ Year of Utilization Review Management and/or Medical Management experience. + Must have active and unrestricted RN license… more
- CVS Health (Tallahassee, FL)
- …for guiding the team in determining correct coding and appropriate documentation during the review of medical records. This role requires a strong focus on ... rework projects. + Ensure staff provide detailed written summaries of medical record review findings and ensure the team articulates findings effectively to… more
- AdventHealth (Ocala, FL)
- …The Coordinator Professional Practice Evaluation is responsible for facilitating the medical staff Peer Review , Ongoing Professional Practice Evaluation (OPPE) ... Policy. This includes the analysis of events that require peer review and the examination of medical records as identified by clinical indicators or triggers is… more
- Molina Healthcare (Tampa, FL)
- …Access and Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/utilization review , and/or other utilization management ... experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of InterQual / MCG guidelines. **Preferred… 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
- Sedgwick (Tallahassee, FL)
- …review process including making a recommendation of specialty for the Independent Medical Review process. + Developing and delivering training materials and ... Best Workplaces in Financial Services & Insurance Sr VP Medical Director (Hourly) The ideal candidate would work 8-20...+ Member of a client Disability Pension Board + Review of identified appeal cases for quality assurance purposes… more
- Sumitomo Pharma (Tallahassee, FL)
- …including pre- and post-marketing US FDA and/or EU ICH safety requirements** + Expertise in medical review of medical review of Individual case safety ... dynamic, highly motivated, and experienced individual for the position of **Associate Medical Director.** The Associate Medical Director will provide hands-on… more
- Centene Corporation (Tallahassee, FL)
- …management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , quality ... medical review of complex, controversial, or experimental medical services, ensuring timely and quality decision making. + Supports effective implementation… more
- MyFlorida (Daytona Beach, FL)
- …Care recommendation, Significant Additional Needs requests, Skilled Nursing Exception Letters, medical review and Incident Management System reporting for ... OPS MEDICAL CASE MANAGER - 67912017 Date: Aug 4,...illness, injury, or accident. Performs all ICF/IID facility admissions review to determine level of reimbursement and completes Facility… more
