- AdventHealth (Altamonte Springs, FL)
- …resource utilization , ultimately resulting in enhanced patient service, improved medical staff satisfaction, and reduced costs. Furthermore, the CMO bears the ... in physician leadership roles within health systems or prominent medical groups. + Business acumen covering strategic planning, information systems … more
- Centene Corporation (Tallahassee, FL)
- … management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , ... state, corporate, and accreditation requirements. + Assists the Chief Medical Director in the functioning of the physician... review studies and evaluates adverse trends in utilization of medical services, unusual provider practice… more
- Evolent (Tallahassee, FL)
- …education and findings with matrixed Physician Business Manager. + Provides medical direction to the support services review process. Responsible for the ... of the Medical leadership team, providing timely medical review of service requests. Oversees the...reviews appeal cases and/or attends hearings for discussion of utilization management decisions. + Strong partnership with Physician… more
- Ascension Health (Jacksonville, FL)
- …issues of physician professional conduct. Ensures adherence and completion of medical staff decisions regarding peer review and physician behavioral ... but not limited to; + Quality and Safety + Utilization Review + Peer Review ...Group. **Work Experience:** + 5 years' experience in a Physician Executive leadership role in an integrated medical… more
- Molina Healthcare (FL)
- …practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment, disease ... productivity standards. Educates and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy … more
- Evolent (Tallahassee, FL)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... when available, within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the… more
- Evolent (Tallahassee, FL)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... and provides clinical rationale for standard and expedited appeals. . Utilizes medical /clinical review guidelines and parameters to assure consistency in the… more
- Evolent (Tallahassee, FL)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... + Provides clinical rationale for standard and expedited appeals. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the… more
- Evolent (Tallahassee, FL)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... + Provides clinical rationale for standard and expedited appeals. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the… more
- Evolent (Tallahassee, FL)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... and provides clinical rationale for standard and expedited appeals. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the… more