- Elevance Health (Miami, FL)
- …critical thinking skills and nursing judgment and experience. + Collaborates with case management nurses on discharge planning, ensuring patient has appropriate ... about plan benefits and physicians and may assist with case management . + Collaborates with leadership in...experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or… more
- CenterWell (Deland, FL)
- …action through the utilization of Performance Improvement principles. + Responsible for review of the appropriate number of Case Managers and clinical staff ... clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the...of care analysis to determine efficiency, the efficacy of case management system as well as any… more
- Evolent (Tallahassee, FL)
- …the mission. Stay for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to ... on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- CVS Health (Tallahassee, FL)
- …Qualifications** - Emergency/critical care experience - Experience working Grievance cases - Case Management or Utilization Management experience ... (PQOC) nurse investigator team manager. This position is responsible for the review and evaluation of protected clinical information and documentation. The PQOC team… more
- AdventHealth (Altamonte Springs, FL)
- …responsibilities, acting as a vital liaison between physicians and Case Management staff to optimize resource utilization , ultimately resulting in enhanced ... base development. + Clinical leadership skills encompass quality and utilization management , clinical effectiveness, outcomes programs, clinical staff… more
- Evolent (Tallahassee, FL)
- …the support services review process. Responsible for the quality of utilization review determinations, including appeals. + Provides input into audit ... member of the Medical leadership team, providing timely medical review of service requests. Oversees the Surgery Field Medical...needed for new hires to educate and train on Utilization management system and Field Medical Director… more
- Humana (Tallahassee, FL)
- …and interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , ... Utilization management experience in a medical management review organization, such as Medicare Advantage,... Case managers or Care managers on complex case management , including familiarity with social determinants… more
- Humana (Tallahassee, FL)
- …and interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , ... Utilization management experience in a medical management review organization, such as Medicare Advantage,... Case managers or Care managers on complex case management , including familiarity with social determinants… more
- Select Medical (Miami, FL)
- …documentation related to the hospital's CQI program. + Performs basic chart review activities with appropriate staff for outcome utilization , infection control ... **Location: Miami, FL** **$10,000 Sign-on Bonus** **Director of Quality Management ** **(DQM)** **Responsibilities** **Position Summary** Coordinates the Medical Quality… more
- Humana (Tallahassee, FL)
- …and interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , ... Utilization management experience in a medical management review organization, such as Medicare Advantage,... Case managers or Care managers on complex case management , including familiarity with social determinants… more