- Highmark Health (Tallahassee, FL)
- …SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health care services, application of ... utilization , identification of opportunities for referral to a Health Coach/case management, and identification and resolution of quality issues. Monitors… more
- MyFlorida (Chattahoochee, FL)
- …Personal Holiday each year. + State Group Insurance coverage options, including health , life, dental, vision, and other supplemental insurance options. + Retirement ... to this position are responsible and accountable for the health , safety, security and well-being of residents and staff...as a role model for residents to reinforce the behavioral and social skills required to be successful in… more
- HCA Healthcare (West Palm Beach, FL)
- …services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed ... in developing department goals and clinical programming. + Performs utilization review as assigned. + Helps with...a 280-bed acute care facility. We have a 124-bed behavioral health unit. We are located in… more
- Highmark Health (Tallahassee, FL)
- …business relationships, the impact of Highmark's business decisions on Informatics, personnel utilization , and the use and planning of technology. The role involves ... units that may assist in the resolution of issues or problems. + Access, review , utilize, contribute content to and participate in the maintenance of the shared… 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 ... Payment Integrity strategies on a pre-payment and retrospective claims review basis. Review process includes a ...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
- Community Based Care of Brevard, Inc. (Brevard, FL)
- …payments and alternative funding sources whenever possible. The position facilitates Team Review Meetings and the utilization review process, reviews ... the county and other locations for client and other meetings. Counseling, Therapy, Behavioral or Mental Health Experience: This position requires a background in… more
- HCA Healthcare (Tallahassee, FL)
- …services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed ... and compliant** + **Certification in Case Management, Nursing, or Utilization Review , preferred** + **Three years of...Leon and Gadsden Counties. Our facilities include a state-of-the-art Behavioral Health Center, Cancer Center, Chest Pain… more
- Highmark Health (Tallahassee, FL)
- …NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the ... **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most… more
- HCA Healthcare (Largo, FL)
- …services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as telemedicine services and free AirMed medical ... in developing department goals and clinical programming. + Performs utilization review as assigned. + Helps with...Health Professional III Licensed - PRN opening. We review all applications. Qualified candidates will be contacted for… more
- HCA Healthcare (Gainesville, FL)
- …services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed ... in developing department goals and clinical programming. + Performs utilization review as assigned. + Helps with...growth, we encourage you to apply for our Mental Health Professional III Licensed opening. We promptly review… more