- CVS Health (Tallahassee, FL)
- …(RN) - active license. + 3+ Years of clinical experience. + 1+ Year of Utilization Review Management and/or Medical Management experience. + Must have active ... a collaborative process to implement, coordinate, monitor and evaluate medical review cases. + Applies the appropriate...use specific criteria to authorize procedures/services or initiate a Medical Director referral as needed. + Assists… more
- Actalent (Sunrise, FL)
- …and appropriateness using standardized Review Criteria. + Coordinate with the Medical Director /Physicians for requests outside standard Review Criteria. ... complex cases, develops internal processes, and educates physicians on utilization review issues. The role involves managing...assigned caseload. + Serve as a liaison between the Medical Director , physicians, and office staff to… more
- Community Health Systems (Naples, FL)
- …of the UR Director /Manager the UR Nurse reviews all admissions for medical necessity, correct orders based on medical condition (inpt vs OBS). Facilitates ... on performance improvement of the UR KPI's. Ensures proper and accurate medical record documentation. **Essential Functions** + Reviews new admissions using 3rd… more
- Centene Corporation (Tallahassee, FL)
- … management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , ... perspective on workplace flexibility. **Position Purpose:** Assist the Chief Medical Director to direct and coordinate the... review studies and evaluates adverse trends in utilization of medical services, unusual provider practice… more
- AdventHealth (Altamonte Springs, FL)
- …assists in drafting and submitting clinical denial appeals, as needed + Develops Medical Director relationships with payors to have open communication and ... Management, the Physician Advisor is responsible for providing clinical review of utilization , claims management, and quality...+ Provides education and serves as a resource to Medical Staff colleagues regarding best practices, Utilization … 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 ... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National...process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
- Humana (Tallahassee, FL)
- …will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex ... Medicaid. + Utilization management experience in a medical management review organization, such as Medicare...on size of region or line of business. The Medical Director conducts Utilization Management… more
- Humana (Tallahassee, FL)
- …role, you will be a key enterprise leader, with responsibility for evolving Humana's Utilization Management of medical review by physician or nurse, with ... performing utilization management for inpatient authorizations training medical director team to assist and facilitate...**Key Responsibilities** **:** + Lead an operational team of Medical Directors to review authorizations and ensure… more
- Evolent (Tallahassee, FL)
- …per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, ... culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Evolent (Tallahassee, FL)
- …per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management process, ... the culture. **What You'll Be Doing:** As a Field Medical Director , MSK Surgery you will be... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more