- Molina Healthcare (Jacksonville, FL)
- …Management (CPHM), Certified Professional in Health Care Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of ... oversight and clinical leadership for health plan and/or market specific utilization management and care management behavioral health programs and chemical… more
- HCA Healthcare (Gainesville, FL)
- …for education, accountability, elevation of professionalism in partnership with Director and Manager of Case Management. + Communicates potential/actual need for ... Worker is to ensure that primary operations of the Case Management Department function efficiently. This position maintains a...for Social Workers based on appropriate level of care, utilization of services and plan of care. Ensures equitable… more
- AdventHealth (New Smyrna Beach, FL)
- …and residency programs. The CMO serves as physician advisor to the Case Management staff, clinical documentation integrity, and serves as physician liaison to ... promote appropriate utilization of resources by the medical staff. Performance improvement...members and lower cost. Direct reports include Med Staff Manager + Clinical Effectiveness including performance improvement, infection control… more
- CenterWell (Tallahassee, FL)
- …Director of Physician Strategy at Utilization Management. The Medical Director conducts Utilization review of the care received by members in an assigned ... this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all… more
- Elevance Health (FL)
- …state mandated policies, and CMS Coverage Determinations, as applicable. + Perform physician-level case review of utilization requests for procedures and ... necessity decisions. + Brings to their supervisors attention, any case review decisions that require Medical Director...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Molina Healthcare (Orlando, FL)
- …managed care experience in the specific programs supported by the plan such as utilization review , medical claims review , long-term services and supports ... Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM),… more
- Elevance Health (Tampa, FL)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... for clinical operational aspects of a program. + Conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss … more
- Elevance Health (FL)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... to discuss review determinations. + May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss … more
- HCA Healthcare (Port Charlotte, FL)
- …to protocol requirements/compliance + Ensures the integrity of the data submitted on Case Report Forms or other data collection tools by careful source document ... review ; monitors data for missing or implausible data +...+ Collects, completes, and enters data into study specific case report forms or electronic data capture systems +… more
- Elevance Health (Tampa, FL)
- …or case management experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or any combination of education and ... (Saturday and Sunday). The **Medical Management Nurse** will be responsible for review of the most complex or challenging cases that require nursing judgment,… more