- Highmark Health (Tallahassee, FL)
- …DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the multidisciplinary team ... :** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities...care of our members **ESSENTIAL RESPONSIBILITIES** + Conduct electronic review of escalated cases against medical policy… more
- AdventHealth (Tampa, FL)
- …Management staff and serves as physician liaison to promote appropriate utilization of resources by the medical staff. Performance improvement efforts will ... Associate CMO assists the CMO in performance improvement, risk management, continuing medical education, medical staff office, medical school affiliation(s)… more
- ChenMed (Pembroke Pines, FL)
- …engagement with patient and family. + Facilitate patient/family conferences to review treatment goals, optimize resource utilization , provide family education ... Participate in surveys, studies and special projects as assigned. + Conduct concurrent medical record review using specific indicators and criteria as approved… more
- Humana (Tallahassee, FL)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, ... will understand how to operationalize this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to… more
- Humana (Tallahassee, FL)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, ... will understand how to operationalize this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to… more
- Travelers Insurance Company (Tallahassee, FL)
- …other medical resources as appropriate. Train and evaluate physician and non- physician medical review personnel and activities. + Stay apprised of ... influences which can impact claim outcomes. Organize and coordinate Travelers' medical review functions. This includes interpreting Federal and State… more
- Elevance Health (Tampa, FL)
- …the medical necessity of requests using clinical criteria. + Performs physician -level case review of musculoskeletal utilization requests. + Conducts ... **Clinical Operations Associate Medical Director** **Orthopedic Spine Surgery** **Carelon Medical...peer-to-peer consultation with ordering physicians, physician assistants and advanced practice nurses regarding established guidelines… more
- University of Miami (Miami, FL)
- …QI training + Improving patient satisfaction + Improving patient safety + Peer review , performance improvement, utilization review , root cause analysis, and ... faculty or staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The Department of… more
- Humana (Tallahassee, FL)
- …clinical group practice management + Utilization management experience in a medical management review organization, such as Medicare Advantage and managed ... management, provider relations, quality of care, audit, grievance and appeal and policy review . The Behavioral Health Medical Director will develop and present… more
- YesCare Corp (Tallahassee, FL)
- …measures including sentinel event review + Actively participant of the Utilization Review process and follow proper procedures. + Follows standard ... **Experience & Requirements** + Graduate of an accredited medical school. + Fully licensed to practice medicine in the state of employment + Board certified in… more