- Molina Healthcare (Tampa, FL)
- …SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years ... and appropriate/accurate billing and claims processing. + Identifies and reports quality of care issues. + Assists with Complex Claim review including DRG… more
- AdventHealth (Maitland, FL)
- …FL **The role you will contribute:** This position is responsible for contract review and interpretation; as well as, the building and maintenance of rates and ... revenue for the Florida division. This position assists the Sr. Contract Manager with ensuring that preferred contract language provides for ease of interpretation… more
- University of Miami (Miami, FL)
- …Department of UMHC SCCC Business Operations has an exciting opportunity for a full time Utilization Review Case Manager to work to work remote. The incumbent ... reviews for clinical utilization and authorization. The Utilization Review Case Manager coordinates...services requiring prior authorization as well as timely concurrent review for continuation of care services +… more
- HCA Healthcare (Tallahassee, FL)
- …position if current and compliant** + **Certification in Case Management, Nursing, or Utilization Review , preferred** + **Three years of nursing experience in ... location._** Come join our team as an RN Case Manager . We care for our community! Just...and patient throughput while supporting a balance of optimal care and appropriate resource utilization . The RN… more
- HCA Healthcare (Tallahassee, FL)
- …position if current and compliant** + **Certification in Case Management, Nursing, or Utilization Review , preferred** + **Three years of nursing experience in ... and patient throughput while supporting a balance of optimal care and appropriate resource utilization . The RN...we encourage you to apply for our RN Case Manager opening. We review all applications. Qualified… more
- CenterWell (Tallahassee, FL)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... position comes with a $15K sign-on bonus.** The **Clinical Manager ** coordinates and oversees all direct care ...requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking… more
- Carnival Cruise Line (Miami, FL)
- …return-to-work planning. The Manager also escalates high-risk cases, conducts care coordination and utilization reviews. Operationally, the role supports ... This role reports to the Senior Manager of Case Management and oversees the daily...crew and their families with professionalism and empathy. + Review clinical care plans for appropriateness and… more
- AdventHealth (Maitland, FL)
- …team player, strong analytic skills, and strong organizational skills. The Medical Economics Manager will manage and mentor managed care staff for both the ... FL **The role you will contribute:** A Medical Economics Manager is responsible for overseeing the analysis and evaluation...support comprehension and replication Leads in the development and review of the annual Managed care net… more
- HCA Healthcare (Sanford, FL)
- …is preferred + BSN is preferred + Certification in Case Management, Nursing or Utilization Review is preferred HCA Florida Lake Monroe Hospital is a 221-bed ... and patient throughput while supporting a balance of optimal care and appropriate resource utilization . You would...we encourage you to apply for our RN Case Manager PRN opening. We review all applications.… more
- HCA Healthcare (Kissimmee, FL)
- …we do. We want you to apply! **Job Summary and Qualifications** The RN Case Manager will facilitate the interdisciplinary plan of care with a focus on ... and patient throughput while supporting a balance of optimal care and appropriate resource utilization . Identify potential...we encourage you to apply for our RN Case Manager PRN opening. We promptly review all… more