- 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
- 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
- Cardinal Health (Tallahassee, FL)
- … Medical Drug Information, including any MSL presentations and Medical /Safety Review Committees + Provides pharmacovigilance support through collaboration ... they can focus on their patients. **What a Senior Medical Science Liaison contributes to Cardinal Health** : The...other status protected by federal, state or local law._ _To read and review this privacy notice click_ here… more
- Humana (Tallahassee, FL)
- …clinical group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed ... **Become a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The … more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …or MCG(R) screening criteria. Responsibilities: + Manages appropriate cases that require medical necessity review such as home care, elective inpatient and ... requests. + Reviews cases referred by the prior-authorization non-clinical medical management coordinator and pre-certification technician staff according to member… 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
- BayCare Health System (St. Petersburg, FL)
- …Coordinator will work onsite on a full-time basis. Responsibilities + Coordinates medical record review with a multi-disciplinary team and distributes results ... for recommendations/actions. + Responsible to ensure quality of medical record health information by verifying the accuracy, consistency, and timeliness. +… more
- BayCare Health System (FL)
- …Coordinator** will work remotely on a full-time basis. **Responsibilities** + Coordinates medical record review with a multi-disciplinary team and distributes ... results for recommendations/actions. + Responsible to ensure quality of medical record health information by verifying the accuracy, consistency, and timeliness. +… more
- Molina Healthcare (Orlando, FL)
- …administrative incentives + Supervises and manages Medical Directors + Develops medical policies and procedures + Conducts peer review **JOB QUALIFICATIONS** ... Utilization/Quality Program management + Previous leadership experience + Peer review , medical policy/procedure development, and provider contracting experience… more
- DOCTORS HEALTHCARE PLANS, INC. (Miami, FL)
- …Coordinator RNs, Medical Management Coordinators. + Manages the daily concurrent review process through department staff, including review of daily hospital ... + Minimum 5-10 years of progressively responsible experience in medical management, or utilization review within a healthcare plan, ACO, or provider system. +… more