- Humana (Tallahassee, FL)
- …management, provider relations, quality of care, audit, grievance and appeal and policy review . The Behavioral Health Medical Director will develop and present ... to the clinical operations team and healthcare organization. The Medical Director's work includes computer based review ...The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, … more
- CenterWell (Tallahassee, FL)
- …will understand how to operationalize this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to ... clinical group practice management. + Utilizationmanagement experience in a medical management review organization, such as Medicare Advantage,managedMedicaid,… more
- Molina Healthcare (Orlando, FL)
- …work on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. JOB DESCRIPTION Job SummaryProvides support for clinical ... member services review assessment processes. Responsible for verifying that services are...requests within required timelines. * Refers appropriate cases to medical directors (MDs) and presents them in a consistent… 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
- Humana (Tallahassee, FL)
- …will understand how to operationalize this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to ... clinical group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed… more
- Elevance Health (FL)
- … medical necessity decisions. + Brings to their supervisors attention, any case review decisions that require Medical Director review or policy ... **Clinical Operations Medical Director** **Carelon MBM** **Virtual:** This role enables...CMS Coverage Determinations, as applicable. + Perform physician-level case review of utilization requests for procedures and interventions listed… more
- Humana (Tallahassee, FL)
- …will understand how to operationalize this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to ... clinical group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed… more
- Evolent (Tallahassee, FL)
- …when available, within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the ... culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key member of...MD review process to reflect appropriate utilization and compliance with… more
- Evolent (Tallahassee, FL)
- …when available, within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the ... setting? Join our Utilization Management team as a Field Medical Director, Cardiovascular Specialist and use your expertise in...MD review process to reflect appropriate utilization and compliance with… more
- Evolent (Tallahassee, FL)
- …and provides clinical rationale for standard and expedited appeals. . Utilizes medical /clinical review guidelines and parameters to assure consistency in the ... the culture. **What You'll Be Doing:** As a Field Medical Director, Oncology, you will be a key member...MD review process to reflect appropriate utilization and compliance with… more