- CenterWell (Daytona Beach, FL)
- …and complaints from patients + Ongoing chart review / audit of clinical staff to ensure quality care and identifying opportunities for education/coaching + ... time dedicated to administrative duties related to oversight of clinical provision of care including, but not...Identifying trends and areas of opportunity in pharmacy utilization (pharmacy management) to impact Part D per Member… more
- Sedgwick (Tallahassee, FL)
- …narcotic use contract with client. + Maintains accurate record system of pharmacy utilization review and complex pharmacy reviews to include cost savings, ... and experience required to include three (3) years of recent clinical practice experience. Utilization practice experience preferred. Insurance/claims industry… more
- Evolent (Tallahassee, FL)
- …experience and as an RN - **Required** + Minimum of 5 years in Utilization Management, health care Appeals, compliance and/or grievances/complaints in a quality ... people with most complex and costly health conditions. Working across specialties and primary care , we seek to connect the pieces of fragmented health care … more
- University of Miami (Miami, FL)
- …via in-basket messaging. + Extensive collaboration with providers, nursing unit, and utilization review department in coordinating admissions. CTU + Must possess ... faculty or staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The University of… more
- HCA Healthcare (Aventura, FL)
- …auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. + Free counseling ... with Progyny and adoption assistance. + Referral services for child, elder and pet care , home and auto repair, event planning and more + Consumer discounts through… more
- HCA Healthcare (Pensacola, FL)
- …interdisciplinary plan of care with a focus on evaluating the appropriateness of clinical care , medical necessity, admission status, level of care , and ... quality outcomes and patient throughput while supporting a balance of optimal care and appropriate resource utilization . Identify potential barriers to patient… more
- BrightSpring Health Services (Sarasota, FL)
- …not limited to: Serving on professional committees such as Advisory Committee or Clinical Record Review / Utilization Review Committee, remaining available ... actively assists the Director in leading and supporting positive outcomes of various clinical objectives for both clinical staff and patients. Responsibilities +… more
- Elevance Health (Tampa, FL)
- …of requests using clinical criteria. + Performs physician-level case review of musculoskeletal utilization requests. + Conducts peer-to-peer consultation ... ** Clinical Operations Associate Medical Director** **Orthopedic Spine Surgery**...practice nurses regarding established guidelines and accepted standards of care as it relates to treatments, surgical procedures, imaging… more
- Veterans Affairs, Veterans Health Administration (West Palm Beach, FL)
- …of health care by participating in programs, following policies, improving utilization of resources and suggesting process changes for clinical programs in ... the Radiation Oncology Section. NOTE: The utilization of the Fee Basis appointments are focused on...who want to contribute to the achievement of quality care standards, as well as the growth and development… more
- Sevita (FL)
- …in the lives of our participants. You'll work alongside a dedicated team of clinical staff and supportive supervisors, while you grow your career. _As an equal ... documentation; maintain confidentiality and adherence to individual rights standards; review and respond accordingly to adverse action regulatory correspondence and… more