- Truist (Winter Park, FL)
- …(Required) **Work Shift:** 1st shift (United States of America) **Please review the following job description:** Provides in-office client and advisor support ... and client acquisition activities. 2. Support administrative fitness efforts through review of relevant reports and ensuring timely updates to book management… more
- Highmark Health (Tallahassee, FL)
- …of the claim rejection and the proper action to complete the retrospective claim review with the goal of proper and timely payment to provider and member ... implementation of effective Payment Integrity strategies on a pre-payment and retrospective claims review basis. Review process includes a review of medical… more
- Evolent (Tallahassee, FL)
- …reviews to be completed by the subject matter expert. + Discusses determinations ( peer to peer phone calls) with requesting physicians or ordering providers, ... available, within the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review… more
- Evolent (Tallahassee, FL)
- …reviews to be completed by the subject matter expert. . Discusses determinations ( peer to peer phone calls) with requesting physicians or ordering providers, ... provides clinical rationale for standard and expedited appeals. . Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD … more
- Evolent (Tallahassee, FL)
- …+ Provides clinical rationale for standard and expedited appeals. + Discusses determinations ( peer to peer phone calls) with requesting physicians or ordering ... available, within the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD review… more
- Elevance Health (FL)
- …medical necessity decisions. + Brings to their supervisors attention, any case review decisions that require Medical Director review or policy interpretation. ... and CMS Coverage Determinations, as applicable. + Perform physician-level case review of utilization requests for procedures and interventions listed above. +… more
- AssistRx (Orlando, FL)
- …+ Prepare quality score reports by associate, team and/or program for management review on a weekly and monthly basis. + Identify service trends and collaborate ... understand how the program enhancement will impact the quality review /score. + Monitoring program AE's and present findings to...+ #TransformingLives Honor: This quarterly award program is a peer to peer honor that recognizes and… more
- University of Miami (Miami, FL)
- …staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . Advanced ... management for side effects related to hematologic oncologic treatment. + Assist with Peer -to- Peer authorizations and filling out medical forms for patients. +… more
- Evolent (Tallahassee, FL)
- …reviews to be completed by the subject matter expert. + Discusses determinations ( peer to peer phone calls) with requesting physicians or ordering providers, ... provides clinical rationale for standard and expedited appeals. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the MD … more
- Humana (Tallahassee, FL)
- …this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all ... physicians by phone to gather additional clinical information or discuss determinations through the Peer 2 Peer process, and in some instances these may require… more