- AdventHealth (Orlando, FL)
- …guidance to clinical questions from Utilization Management staff involved in authorizations, concurrent review , and denials as a back up to UM Physician Advisory as ... necessity criteria Responsible for reviewing Clinical Documentation and performs secondary review for escalations Evaluates and reviews charts for Quality indicators… 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)
- …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
- Elevance Health (Miami, 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
- 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 (Miami, FL)
- …required by law. The **Medical Director-Dermatology Appeals** is responsible for the review of appeals for physical health medical services, to ensure the ... clinical operational aspects of a program. + May conduct peer -to- peer clinical reviews with attending physicians or...reviews with attending physicians or other providers to discuss review determinations + Serve as a resource and consultant… 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 ... from inpatient or post-acute care environments. A remote possibility exists of doing peer -to- peer discussions with an external provider. Some roles include an… 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
- Otsuka America Pharmaceutical Inc. (Tallahassee, FL)
- **Job Description:** + Manage the tactical development and execution of HCP peer -to- peer medical education (DSE and brand), congress presence, as well as other ... managing agency partners ushering all necessary resources through the Promotional Review Committee process, from draft to final approval. **Qualifications:** +… more