- CVS Health (Tallahassee, FL)
- …will review prior claims to address potential impact on current case management and eligibility status. Focus assessments and/or questionnaires are designed ... impact on our members, who are enrolled in Care Management and present with a wide range of complex...community + Utilizes weekly and daily reporting to identify utilization for the purpose of reducing Emergency Department … more
- AdventHealth (Altamonte Springs, FL)
- …as a clinical leader to the hospital's medical staff providing guidance in case management , appropriate levels of care for patients, efficient utilization ... + Works with medical staff to obtain appropriate documentation and assist case management with clinical interpretation necessary to ensure appropriate payment… more
- MyFlorida (Ocala, FL)
- …and performance targets. MONITORING AND QUALITY REVIEW : Reviews and analyzes case records in accordance with the Quality Management System Plan and ... regulations, policies, and procedures. Develops and uses tracking systems to monitor case status and ensure staff complete assignments to deliver customer service… more
- Humana (Tallahassee, FL)
- …CMS Guidelines, MCG and/or InterQual guidelines. + 2+ years of Utilization Management (UM), Pre-Auth, and/or other managed care review experience. + 1+ years ... Refers to internal stakeholders for review depending on case findings. Educates providers on utilization and medical management processes. + Enters and… more
- AdventHealth (Orange City, FL)
- …of Nursing. + Health-related Master's degree or MSN. + Prior Care Management / Utilization Management experience. + ACM/CCM Certification. This facility ... for each position may vary based on geographical location. **Category:** Case Management **Organization:** AdventHealth Fish Memorial **Schedule:** Part-time… more
- BayCare Health System (Lakeland, FL)
- …and agency staff. + Participates with Case Manager on initial Plan of Care review with a focus on quality, utilization and individual patient care goals. + ... bodies within the area of responsibility. + Ensure quality assurance program and utilization review is followed in accordance with Home Care protocol. +… more
- MyFlorida (Bradenton, FL)
- …+ Monitor, evaluate and improve the overall performance of the STD Field Operations case management activities. + Responsible for overseeing the management ... delivery factors. Ensures staff receive training in HMS (Health Management System) on new updates and versions within 30...Conducts annual reviews and periodic revisions according to the review schedule; Coordinates review and revision of… more
- University of Miami (Miami, FL)
- …clinic pharmaceuticals. + Contact Local Health Department for Communicable Disease Case Reporting. Financial Management : + Collaborate with Executive Director ... to provide safe, quality care. + Responsible for the utilization and maintenance of appropriate nursing care plans, and...both internal and external to the clinical operation and review Risk Management events consistently to identify… more
- AdventHealth (Deland, FL)
- …+ BSN + Health-related Master's degree or MSN + Prior Care Management / Utilization Management experience ACM/CCM Certification This facility is ... for each position may vary based on geographical location. **Category:** Case Management **Organization:** AdventHealth DeLand **Schedule:** Part-time **Shift:**… more
- Veterans Affairs, Veterans Health Administration (Daytona Beach, FL)
- …responsible to provide comprehensive gender specific care, under the PACT model and intensive case management to a panel of patients with complex chronic medical ... team to closely follow their patients through care coordination and intensive case management utilizing a multi-disciplinary team approach to work towards… more