- 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)
- …when available, within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the ... reviewing cases that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests...MD review process to reflect appropriate utilization and compliance with… more
- Molina Healthcare (Miami, FL)
- …Supports BH committees for quality compliance. * Implements clinical practice guidelines and medical necessity review criteria * Tracks all clinical programs for ... of sanctions from Medicaid or Medicare. **Preferred Experience** * Peer Review , medical policy/procedure development, provider contracting experience. *… 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 ... Imaging cases, that do not initially meet the applicable medical necessity guidelines, as well as other imaging requests...MD review process to reflect appropriate utilization and compliance with… 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 Associate Medical Director** **Carelon Medical Benefit Management** **Radiology Benefit Management** Surgery (Including: General,… more
- Molina Healthcare (Jacksonville, FL)
- …quality compliance. * Implements behavioral health specific clinical practice guidelines and medical necessity review criteria. * Tracks all clinical programs ... JOB DESCRIPTION Job SummaryProvides medical oversight and expertise related to behavioral health and chemical dependency services, and assists with implementation of… more
- Humana (Tallahassee, FL)
- …insurance, or other healthcare providers. + Utilization management experience in a medical management review organization, such as Medicare Advantage, Managed ... caring community and help us put health first The Medical Director actively uses their medical background,...first The Medical Director actively uses their medical background, experience, and judgement to make determinations whether… more
- BayCare Health System (Tampa, FL)
- …on-site on a full-time basis. **Responsibilities** + The Quality Data Coordinator - Medical Records coordinates medical record review with a ... distributes results for recommendations/actions. + Responsible to ensure quality of medical record health information by verifying the accuracy, consistency, and… more
- Veterans Affairs, Veterans Health Administration (Orlando, FL)
- …and recognize and eliminate recording artifacts. Knowledge of medical terminology and medical record organization to review medical records, sleep study ... post-test calibrations. Knowledge of medical terminology and medical record organization to review medical records, sleep study orders, consent forms,… more
- Molina Healthcare (Tampa, FL)
- …Public Health, Healthcare Administration, etc. **PREFERRED EXPERIENCE:** + Peer Review , medical policy/procedure development, provider contracting experience. + ... Summary** Responsible for serving as the primary liaison between administration and medical staff. Assures the ongoing development and implementation of policies and… more