- Elevance Health (Tampa, FL)
- …area to refer or assign case ( utilization management , case management , QI, Med Review ). + Provides information regarding network providers ... Gathers clinical information regarding case and determines appropriate...and documents all actions. + Responsibilities exclude conducting any utilization management review activities which… more
- Elevance Health (Tampa, FL)
- …to work East Coast time zone hours.** The **Medical Director** will be responsible for utilization review case management for Commercial business in the ... and external physicians. + May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers...state or territory of the United States when conducting utilization review or an appeals consideration and… more
- Elevance Health (Tampa, FL)
- …is providing services in multiple states. **Preferred Capabilities, Skills and Experiences:** + Case Management experience. + Certification as a Case ... assessment within 48 hours of receipt and meet the criteria._** The **Telephonic Nurse Case Manager II** is responsible for care management within the scope of… more
- CVS Health (Tallahassee, FL)
- …health professionals to influence appropriate member care. . Attends and participates in case rounds, including utilization management rounds for behavioral ... company expense reimbursement policy **Preferred Qualifications:** . Behavioral Health Experience . Case management in an integrated model . Experience providing… more
- Amergis (Gainesville, FL)
- …+ Current RN licensure in state practicing + At least one year of Case Management experience preferred + Current CPR if applicable + TB questionnaire, ... Salary: $1800 / Week The RN Case Manager is responsible for coordinatingcontinuum of care...at least 18 years of age + Experience with Utilization Review Benefits At Amergis, we firmly… more
- Cleveland Clinic (Vero Beach, FL)
- …one year of eligibility (CTM, ACM, CCM or AHA) + 2 years of recent experience in utilization review , quality or care management + Knowledge of acute care and ... one of the most respected healthcare organizations in the world. RN Case Managers work collaboratively with inter-professional teams across the continuum of care… more
- AdventHealth (Orlando, FL)
- …role you'll contribute:** The Population Health Case Manager (PHCM) ensures effective utilization and case management oversight activities as defined by ... + Mentors colleagues and encourages implementation of best practice guidelines + Case Management : + Determine patient risk for rehospitalization and appropriate… more
- Evolent (Tallahassee, FL)
- …reviewers are supported by Physician clinical review staff (MDs) in the utilization management determination process. **What You Will Be Doing:** + Reviews ... Therapy you will be a key member of the utilization management team. We can offer you...outcomes. **Collaboration Opportunities: ** + Functions in a clinical review capacity to evaluate all cases, which do not… more
- Molina Healthcare (St. Petersburg, FL)
- …of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. ... SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years… more
- BAYADA Home Health Care (Orlando, FL)
- …for quality and adherence to policies and procedures. As a member of the Medicare Case Management (MCM) office, individuals in this role are expected to maintain ... + Candidates should be available Monday-Friday from 8:30am-5:00pm. _Medicare, Coder, OASIS Review , Utilization Review , Quality Assurance, Remote, Home Health… more