- Prime Therapeutics (Tallahassee, FL)
- …of post-degree clinical experience. + Experience in managed care, specialty drugs, care management and utilization review. + Meets Credentialing criteria. + At ... for drug services. + Will actively maintain a required case load and the activities to reach overall goals...appeals program. + Participates in meetings and consults with management on regular basis to discuss member interaction and… more
- Elevance Health (FL)
- …a State agency.*_ **Preferred Skills, Capabilities and Experiences:** + 1-2 years Utilization Management experience strongly preferred. + Strong oral, written, ... with providers and external physicians. + May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss… more
- Baker Construction (Tampa, FL)
- …in establishing clinics, managing first report of injuries, and assisting with co-worker case management + Follows Company Recruitment and Hiring Guidelines + ... and other reports + Alerts the Superintendent and Project Manager of project impact relating to resource management...utilization , MBE/SBE participation, etc., and advises the Project Manager of issues + Interfaces with Safety and Risk… more
- J&J Family of Companies (Naples, FL)
- …Electrophysiology US Field Sales & Service group reporting to a New Technology Manager (NTM), and closely partnering with, the Regional Business Director (RBDs) and ... Territory Managers (TMs). Under the general direction of the manager and in accordance with all applicable federal, state and local laws/regulations and Corporate… more
- Elevance Health (Tampa, FL)
- …preferred. + Extensive spine surgery experience preferred. + Experience with utilization management , especially with CMS guidelines preferred. + **Orthopedic ... medical necessity of requests using clinical criteria. + Performs physician-level case review of musculoskeletal utilization requests. + Conducts peer-to-peer… more
- Molina Healthcare (St. Petersburg, FL)
- …Clinical Coder, Certified Medical Audit Specialists, Certified Case Manager , Certified Professional Healthcare Management , Certified Professional in ... of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals.… more
- BayCare Health System (Lakeland, FL)
- …the Emergency Management program for office and agency staff. + Participates with Case Manager on initial Plan of Care review with a focus on quality, ... bodies within the area of responsibility. + Ensure quality assurance program and utilization review is followed in accordance with Home Care protocol. + Oversees and… more
- MyFlorida (Orlando, FL)
- …eligibility and makes recommendations for licensure to supervisor/regional program manager . + Investigates complaints on licensed providers and illegal child ... + Attains a high proficiency/skill level as demonstrated through the competent utilization of the program's hardware, software, system applications and web pages. +… more
- Elevance Health (FL)
- …patients with IDD and patients with special needs is preferred. + Home Health, Utilization Management or Case Management experience strongly preferred. ... community agencies and appropriate provider/network. + Refers member to catastrophic case management . **Minimum Requirements:** Requires AS in nursing and… more
- AdventHealth (Palm Coast, FL)
- …the Surgical program creates: high degree of patient satisfaction; maintains/increases surgical utilization ; meets basic surgeon needs, ie, accurate case start ... and Anesthesia Support Services. The Director will also work with the Manager of Anesthesia Professional Services and provides oversight support when needed.… more