- Ascension Health (Jacksonville, FL)
- …and continuous improvement of services, policies, processes, and programs, including medical practice review , governance, credentialing, privileging, peer ... of physician professional conduct. Ensures adherence and completion of medical staff decisions regarding peer review and...completion of medical staff decisions regarding peer review and physician behavioral issues. + Leads the development… more
- BayCare Health System (Tampa, FL)
- …related parties to ensure appropriate level of care through comprehensive concurrent review for medical necessity of outpatient observation and inpatient stays ... of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior responsibilities include:** + Functions as the primary… more
- BayCare Health System (Clearwater, FL)
- …related parties to ensure appropriate level of care through comprehensive concurrent review for medical necessity of outpatient observation and inpatient stays ... of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior responsibilities include:** + Functions as the primary… more
- 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
- Humana (Tallahassee, FL)
- …put health first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical director work ... rules, Humana policies and medical necessity. The Medical Director's work includes computer based review ...The Medical Director's work includes computer based review of moderately complex to complex appeals for coverage… 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)
- …+ Provides clinical rationale for standard and expedited appeals. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the ... **What You'll Be Doing:** As a Vascular Surgery, Field Medical Director you will be a key member of...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 ... Doing: + Serve as the Physician match reviewer in Medical Oncology and imaging cases, that do not initially...MD review process to reflect appropriate utilization and compliance with… more