- Highmark Health (Tallahassee, FL)
- …insights and guidance to internal departments. The Analyst conducts audits of Medical Directors, Utilization Management (UM) and Case Management (CM) ... Risk Compliance Analyst is responsible for monitoring and analyzing medical and utilization management activities to ensure compliance with internal policies,… more
- Deloitte (Jacksonville, FL)
- …PMs, Project Coordinators, etc. + 3+ years of project / program financial management (eg, Planning, Forecasting, Budgeting, Business Case Development, etc.) in ... you will play a key role in leveraging leading program and project management practices and methodologies to enable world-class delivery of our major internal… more
- ChenMed (Tamarac, FL)
- …treatment, development of the plan of care, health education, specialty referrals, case management referrals, follow-up and clear documentation according to ... and explain primary care provider role. Facilitate patient/family conferences to review treatment goals, optimize resource utilization , provide family education… more
- MyFlorida (Jacksonville, FL)
- …deadlines, work objectives and time utilization with employees. MONITORING AND QUALITY REVIEW : Reviews and analyzes case records in accordance with the ESS ... New Quality Management System. Discuss case findings with staff...checks through local law. Knowledge, skills and abilities, including utilization of equipment, required for the position : Knowledge… more
- AdventHealth (Orlando, FL)
- …documents avoidable days, and facilitates progression of care. Collaborates with Utilization Management staff for collaboration on patient status changes ... degree in Nursing + Health-related masters degree or MSN + Prior Care Management / Utilization Management experience + Professional Certification + Prior… more
- Molina Healthcare (Tampa, FL)
- …Chief Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + ... be required. + Serves as a clinical resource for Utilization Management , Chief Medical Officer, Physicians, and...the specific programs supported by the plan such as Utilization Review , Medical Claims Review ,… more
- AdventHealth (Winter Garden, FL)
- …documents avoidable days, and facilitates progression of care. Collaborates with Utilization Management staff for collaboration on patient status changes ... degree in Nursing + Health-related masters degree or MSN + Prior Care Management / Utilization Management experience + Professional Certification This… more
- Genesis Healthcare (Oxford, FL)
- …of the rehabilitation department, including oversight related to case management , quality improvement, care planning, clinical utilization , and patient ... Director of Rehab PTA is responsible for the efficient management of rehabilitation services in their assigned account(s). This...Director in the timely completion of the annual merit review for therapy staff. 6. Assists Clinical Operations Area… more
- Datavant (Tallahassee, FL)
- …###@datavant.com . We will review your request for reasonable accommodation on a case -by- case basis. For more information about how we collect and use your ... As a Salesforce System Architect, you will be responsible for user management , data maintenance, security configuration, and training users on using Salesforce… more
- Ascension Health (Jacksonville, FL)
- **Details** + **Department:** Case Management + **Schedule:** Part-time | Hybrid (frequently on site) + **Hospital:** Ascension St. Vincent + **Location:** ... in a hospital setting, preferably with some Physician Advisory/ Utilization Management work experience. If you are...of stay determination. + Assist and manage the denial management process. + Review and offer suggestions… more