- Molina Healthcare (St. Petersburg, FL)
- … Directors + Develops medical policies and procedures + Conducts peer review **JOB QUALIFICATIONS** **REQUIRED EDUCATION:** * Doctorate Degree in Medicine ... experience in Utilization/Quality Program management + Previous leadership experience + Peer review , medical policy/procedure development, and provider… more
- Cleveland Clinic (Weston, FL)
- …regarding quality management regulations and standards of care. + Support medical staff quality assurance activities such as peer review , ongoing ... as outlined by regulations, bylaws, and rules and regulations established by the medical staff . + Act as the primary resource for staff to facilitate… more
- Elevance Health (FL)
- …The **Clinical Operations Medical Director** is responsible for supporting the medical management staff ensuring timely and consistent medical decisions ... Perform physician-level case review , following initial nurse review , of Medical Oncology regimens and supportive...necessity of requests using guidelines and client-specific health plan medical policy. + Conduct peer -to- peer … more
- University of Miami (Miami, FL)
- …discipline. The Medical Director shall be a member of the active Medical Staff and shall be administratively responsible for working collaboratively with ... + Improving patient satisfaction + Improving patient safety + Peer review , performance improvement, utilization review...discipline + Identify and help resolve conflict between the medical staff of the discipline and hospital… 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 ... rationale for standard and expedited appeals. + Discusses determinations ( peer to peer phone calls) with requesting...(NCQA) guidelines. + Ensures documentation of all communications with medical office staff and/or MD provider is… 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 ... completed by the subject matter expert. . Discusses determinations ( peer to peer phone calls) with requesting...Clinical Reviewers. . Ensures documentation of all communications with medical office staff and/or MD provider is… more
- Evolent (Tallahassee, FL)
- …+ Provides clinical rationale for standard and expedited appeals. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the ... completed by the subject matter expert. + Discusses determinations ( peer to peer phone calls) with requesting...Clinical Reviewers. + Ensures documentation of all communications with medical office staff and/or MD provider is… more
- HCA Healthcare (Loxahatchee, FL)
- …senior-level leadership to the infection control, risk management, safety, and medical staff credentialing functions, ensuring the collaboration and coordination ... to improve the functionality and effectiveness of the hospital medical staff organization. + Partners with ...and quality profiling. Serves as a member of hospital's peer review committees as requested. Business Development… 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 ... completed by the subject matter expert. + Discusses determinations ( peer to peer phone calls) with requesting...expedited appeals. + Ensures documentation of all communications with medical office staff and/or MD provider is… 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 ... completed by the subject matter expert. + Discusses determinations ( peer to peer phone calls) with requesting...Clinical Reviewers. + Ensures documentation of all communications with medical office staff and/or MD provider is… more