Clinical Coding Analyst RN, Consultant Blue Cross and Blue Shield AssociationClinical Coding Analyst RN, ConsultantMiami, FLIn this role you will be supporting the FCR team in addition to a small clinical coder team of 2 clinical coders who will be responsible for performing in-depth quality audits of hospital claims to support ICD-10-CM and ICD-10 PCS codes as well as EDC (Emergency Department Coding), MS-DRG and APR-DRG reviews based on clinical determination. Acts as a resource and helps to validate post claim DRG downgrade denials related to coding and clinical determination to support appeal strategy, tracking by disease, payer and denial activity and works with teams to create transparency and improvements to mitigate and prevent denials.
Assistant Professor Of Clinical - Pediatrics, Child Protection Team University of MiamiAssistant Professor Of Clinical - Pediatrics, Child Protection TeamMiami, FLThe Team Physician will mainly be located in the Desai Sethi Medical Center, however, will be expected to travel to the CPT South Office located at the UHealth South Specialty Clinic, as well as different locations throughout Monroe County. The State of Florida, Department of Health (DOH), contracts with the University of Miami, Department of Pediatrics to provide for a coordinated interdisciplinary team approach for the evaluation, diagnosis and treatment of child maltreatment.
Clinical Pharmacist - Oncology - UTower University of MiamiClinical Pharmacist - Oncology - UTowerMiami, FLPrimary Duties and Responsibilities: Directs and optimizes pharmacotherapy for medically complex oncology populations, including patients with relapsed or refractory malignancies, those enrolled in clinical trials, and recipients of advanced therapies such as bispecific therapies and other novel immunotherapies. Leads the implementation of innovative clinical practices, technologies, and evidence-based initiatives within their service area, collaborating with interdisciplinary teams to expand clinical pharmacy services, optimize patient care, and advance quality improvement efforts.
Manager, Nursing & Clinical Education, Full-Time University of MiamiManager, Nursing & Clinical Education, Full-TimeMiami, FLUHealth-University of Miami Health System, South Florida's only university-based health system, provides leading-edge patient care powered by the ground breaking research and medical education at the Miller School of Medicine. Current Employees: If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here to log in to Workday to use the internal application process.
Medical Director - Individual Segment Elevance Health IncMedical Director - Individual SegmentMiami, FLMinimum Requirements: Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA). Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US.
Medical Director- Florida Medicare Elevance Health IncMedical Director- Florida MedicareMiami, FLMinimum Requirements: Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA). The Medical Director is responsible for utilization management, medical necessity clinical reviews of both inpatient and outpatient authorizations, appeals medical necessity reviews, and peer to peer clinical discussions.
NewBehavioral Health Medical Director - Psychiatrist - Florida Medicaid Elevance Health IncBehavioral Health Medical Director - Psychiatrist - Florida MedicaidMiami, FLThe Behavioral Health Medical Director is responsible for supporting behavioral health utilization management activities for Florida Medicaid, conducting peer-to-peer discussions with providers, performing chart reviews as needed, supporting utilization management and care management teams with clinical expertise, participating in clinical rounds and providing psychiatric consultation, and delivering clinical feedback to both external providers and internal staff. Minimum Requirements: Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA).
Medical Director- Florida Medicare Elevance HealthMedical Director- Florida MedicareMiami, FloridaRequires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA). The Medical Director is responsible for utilization management, medical necessity clinical reviews of both inpatient and outpatient authorizations, appeals medical necessity reviews, and peer to peer clinical discussions.
NewBehavioral Health Medical Director – Psychiatrist – Florida Medicaid Elevance HealthBehavioral Health Medical Director – Psychiatrist – Florida MedicaidMiami, FloridaThe Behavioral Health Medical Director is responsible for supporting behavioral health utilization management activities for Florida Medicaid, conducting peer-to-peer discussions with providers, performing chart reviews as needed, supporting utilization management and care management teams with clinical expertise, participating in clinical rounds and providing psychiatric consultation, and delivering clinical feedback to both external providers and internal staff. Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA).
Medical Director - Individual Segment Elevance HealthMedical Director - Individual SegmentMiami, FLMinimum Requirements: Requires MD or DO and Board certification approved by one of the following certifying boards is required, where applicable to duties being performed, American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA). Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US.
Regional Medical Scientific Director (RMSD) - Gynecologic Malignancies - LA, MS, AL, GA, FL, SC Merck & Co IncRegional Medical Scientific Director (RMSD) - Gynecologic Malignancies - LA, MS, AL, GA, FL, SCMiami, FL$210,400–$331,100 / yearUpon request from Global Clinical Trial Operations (GCTO), Recommends study sites and identifies potential investigators to participate in phase II-IV clinical development programs, conducts Site Initiation Visits (SIVs), and detects barriers to patient enrollment and retention efforts to achieve study milestones. Upon request from Global Center for Scientific Affairs (GCSA), Initiates discussions with SLs and/or potential investigators that include scientific/data exchange within our AOI to determine the alignment with our research strategies, studies concepts, scientific merit, and qualifications for a specific compound or trial.
Faculty (Rank TBD) / Director - Predoctoral Orthodontics - 993526 Nova Southeastern UniversityFaculty (Rank TBD) / Director - Predoctoral Orthodontics - 993526Fort Lauderdale-Davie, FLFor Professor rank: Continued professional growth and success in full-time university teaching for five (5) years at the rank of Associate Professor; significant scholarly contributions to the university, higher education, or one's academic area(s) of specialization that have that have been recognized as substantial by one's peers. For Associate Professor rank: Continued professional growth and success in full-time university teaching for four (4) years at the rank of Assistant Professor; scholarly contributions to the university, higher education, or one's academic area(s) of specialization that have received peer recognition.
Medical Director Adelphi StaffingMedical DirectorMiami, FloridaSupervise and evaluate HCC clinical staff including MDs, DOs, and mid-level providers. • Support Staff Available: RNs, APPs, Case Managers, Practice Manager.
Associate Medical Director, Infection Prevention & Antimicrobial Stewardship Jackson Health SystemAssociate Medical Director, Infection Prevention & Antimicrobial StewardshipMiami, FLWe are looking for a seasoned and Board Certified Infectious Diseases physician who thrives in a fast-paced environment, collaborates effectively with multidisciplinary teams, and demonstrates strong leadership under pressure. Jackson Health System is seeking an experienced and dynamic Associate Medical Director of Infection Prevention & Antimicrobial Stewardship to join our leadership team at Jackson Memorial Hospital.
Associate Director, PCS Level 1, Perdue Medical Center, Cutler Bay, Full-Time, Days Jackson Health SystemAssociate Director, PCS Level 1, Perdue Medical Center, Cutler Bay, Full-Time, DaysCutler Bay, FLDevelops, communicates, implements and evaluates an on-going Performance Improvement plan for the Designated Service Area(s) consistent with the philosophy of the Executive Performance Improvement Council (EPIC) and the Designated Service Area Performance committee. Participates with the Medical staff and other disciplines responsible for patient care to develop, implement, monitor and evaluate appropriate clinical care to meet the needs of the patients within the Designated Services Area(s).
Area Director, Florida Neko HealthArea Director, FloridaMiami, FloridaProven experience in a senior operational leadership role (Area Director, Regional Director, District Leader, General Manager or equivalent) within apremium, consumer‑facing, multi ‑ site environment such as premium healthcare‑adjacent, wellness, fitness or technology‑enabled services with physical operations/stores. While these are still being built and refined, the role is firmly focused on adoption rather than reinvention — shaping how these ways of working show up locally, strengthening them through practical execution, and enabling teams to operate with increasing confidence, consistency, and care.
Director, Commercial Analytics & Information Summit TherapeuticsDirector, Commercial Analytics & InformationPrinceton, Florida$203,000–$253,000 / yearHARMONi: Phase 3 clinical study which was intended to evaluate ivonescimab combined with chemotherapy compared to placebo plus chemotherapy in patients with EGFR-mutated, locally advanced or metastatic non-squamous NSCLC who were previously treated with a 3rd generation EGFR TKI. Collaborative Responsibilities - Market Research Support Apply claims, EHR, lab, and alternative data sources – including digital/omnichannel, payer, and hub – to support patient journey modeling, segmentation, and drivers-of-business analysis in partnership with Marketing.
Director, Marketing Operations Summit TherapeuticsDirector, Marketing OperationsPrinceton, Florida$203,000–$253,000 / yearOwns marketing operational infrastructure including the promotional review committee (PRC) workflow and the content lifecycle behind it, promotional material fulfillment and warehousing, speaker program and event operations, meetings and events coordination across the commercial organization, agency and vendor management, budget management, and marketing performance reporting. The Director, Marketing Operations supports the Market Access team by running their materials through the promotional review committee (PRC) and handling the production and distribution behind them, owns meetings and events coordination for the commercial organization, owns budget management for marketing operations, a.
Medical Director - Physical Medicine & Rehabilitation - Evicore - Remote The Cigna GroupMedical Director - Physical Medicine & Rehabilitation - Evicore - RemoteFLRemote$207,800–$346,300 / yearThese states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
Medical Director (Aetna One Advocate) CVS Health CorpMedical Director (Aetna One Advocate)FL$174,070–$374,920 / yearOur teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Serve as lead clinical and business liaison to network providers and facilities, supporting effective execution of medical services programs.