- Community Based Care of Brevard, Inc. (Rockledge, FL)
- …families to "close the loop". This position produces necessary reports on utilization in a culturally competent, flexible and responsive service delivery system. ... of families referred for services by DCF that includes review and discussion of family situation and risk level,...exceed their expectations; help evaluate needs and options; show care and concern to demonstrate customer importance and value.… more
- Humana (Tallahassee, FL)
- …insurance, other healthcare providers, clinical group practice management + Utilization management experience in a medical management review organization, ... participate in meetings involving care management, provider relations, quality of care , audit, grievance and appeal and policy review . The Behavioral Health… more
- CenterWell (Tallahassee, FL)
- …member service or customer service telephone experience desired + Experience with Utilization Review and/or Prior Authorization, preferably within a managed ... a part of our caring community and help us put health first** Utilization Management Administration Coordinator II , non- clinical , supports the UM operations… more
- Veterans Affairs, Veterans Health Administration (Miami, FL)
- …a capabilities model to achieve goals for eligibility, referral and authorization, care coordination, and utilization management to ensure improved Veteran ... staff, and budget in support of organizational goals and commitments. Establishes care coordination guidelines to assure appropriate utilization of services,… more
- Elevance Health (Miami, 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 ... and serve as clinical /strategic advisor to enhance clinical operations. May identify cost of care ...reviews with attending physicians or other providers to discuss review determinations and patient's office visits with providers and… more
- Healthfirst (FL)
- The Case Manager, Utilization Management coordinates the care plan for assigned members and conducts pre-certification, concurrent review , discharge ... Monitors assigned case load to meet performance metric requirements + Functions as a clinical resource for the multi-disciplinary care team in order to maximize… more
- Evolent (Tallahassee, FL)
- … expertise in developing cardiovascular programs that include improvements to clinical effectiveness of utilization management (UM) and risk-based models.** ... Process improvement and enhancement of **provider engagement to help ensure high value care delivery.** + Offer ** clinical rationale for standard and expedited… more
- Ascension Health (Jacksonville, FL)
- …and opportunity. + Responsible for monitoring, measurement and quality improvement of clinical care utilizing evidence-based best practices to support, promote ... an advocate on behalf of our patients, physicians and clinical staff. Identifies, cultivates and develops emerging physician leaders,...but not limited to; + Quality and Safety + Utilization Review + Peer Review … more
- YesCare Corp (Tallahassee, FL)
- …measures including sentinel event review + Actively participant of the Utilization Review process and follow proper procedures. + Follows standard ... staff. + Ensure and provide on-call services. + Annually review and approve clinical protocols, policies and...+ Participate in onboarding new providers and nursing staff. ** Clinical ** + Provides typical community standard care … more
- University of Miami (Miami, FL)
- …and clinical performance improvement. + Responsible for assuring patient care is delivered in alignment with hospital mission, nursing department goals and ... their given assignments in order to provide safe, quality care . + Responsible for the utilization and...and departmental expansion. + Assists with the development/revision and review of clinical policies and procedures. +… more