- Humana (Tallahassee, FL)
- …and help us put health first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The Medical ... of the Medicare rules, Humana policies and medical necessity. The Medical Director 's...and Procedures, and clinical literature as appropriate. Medical Directors will learn Medicare Part D… more
- Humana (Tallahassee, FL)
- **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 ... Medical Director work assignments involve moderately complex to complex issues...group practice management. + Utilization management experience in a medical management review organization, such as Medicare … more
- Evolent (Tallahassee, FL)
- …non- clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Molina Healthcare (St. Petersburg, FL)
- …NCQA-compliant clinical quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. ... + Facilitates conformance to Medicare , Medicaid, NCQA and other regulatory requirements. + Reviews...experience, including: + 2 years previous experience as a Medical Director in a clinical … more
- Evolent (Tallahassee, FL)
- …the mission. Stay for the culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management team. ... on-going training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- CenterWell (Jacksonville, FL)
- …our caring community and help us put health first** The Associate Medical Director (AMD) is an instrumental clinical leader of our primary care team, ... indicators (KPIs), such patient experience via Net Promoter Score (NPS) and Medicare clinical quality via HEDIS, meeting local and organizational goals… more
- Evolent (Tallahassee, FL)
- …for the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director , Oncology, you will be a key member of the utilization management ... rationale for standard and expedited appeals. . Utilizes medical / clinical review guidelines and parameters to assure...timely and accurate manner. . May assist the Senior Medical Director in research activities/questions related to… more
- Evolent (Tallahassee, FL)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Field Medical Director , MSK Surgery you will be a key member of the utilization ... rationale for standard and expedited appeals. + Utilizes medical / clinical review guidelines and parameters to assure...timely and accurate manner. + May assist the Senior Medical Director in research activities/questions related to… more
- BAYADA Home Health Care (Jacksonville, FL)
- …and compassionate ** Director ** to manage operations at our **Jacksonville, FL Medicare -certified Home Health office** . The ideal candidate will have a strong ... background in healthcare administration, regulatory compliance ( Medicare Conditions of Participation), clinical coordination, and business operations. This… more
- CenterWell (Daytona Beach, FL)
- …and help us put health first** Job Description Summary The Associate Medical Director (AMD) is an instrumental clinical leader of our primary care team, ... indicators (KPIs), such patient experience via Net Promoter Score (NPS) and Medicare clinical quality via HEDIS, meeting local and organizational goals… more