- Ascension Health (Jacksonville, FL)
- …regulatory requirements, appropriate utilization of alternate levels of care , community resources, clinical documentation improvement, coding, quality and/or ... recent work experience in a hospital setting, preferably with some Physician Advisory/ Utilization Management work experience. If you are ready to join a talented… more
- Prime Therapeutics (Tallahassee, FL)
- … clinical experience. + Experience in managed care , specialty drugs, care management and utilization review . + Meets Credentialing criteria. + ... for drug infusion services versus the hospital outpatient facility.Discusses financial and clinical considerations with members who are considering care at a… more
- Evolent (Tallahassee, FL)
- …healthcare analytics or utilization management within a payer, provider, clinical vendor, managed care , or healthcare consulting environment. + Strong ... (FDA), and various prior authorization lists, facilitating timely decision-making for clinical and business review teams. + Demonstrate strong analytical… more
- University of Miami (Miami, FL)
- …of patient flow + Plans, organizes, and facilitates processes to support physicians, clinical care team in development of order sets and physician documentation ... + Experience in basic PC troubleshooting preferred + Experience in a hospital based clinical care giving environment preferred + Experience in using clinical … more
- HCA Healthcare (Sanford, FL)
- …interdisciplinary plan of care with a focus on evaluating the appropriateness of clinical care , medical necessity, admission status, level of care , and ... and patient throughput while supporting a balance of optimal care and appropriate resource utilization . You would...is preferred + Certification in Case Management, Nursing or Utilization Review is preferred HCA Florida Lake… more
- CVS Health (Jacksonville, FL)
- …to members and providers. Leads all aspects of utilization review /quality assurance, directing case management Provides clinical expertise and business ... transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care... clinical quality and effective use of health care resources. **This is a remote based (work at… more
- Veterans Affairs, Veterans Health Administration (West Palm Beach, FL)
- …care delivery model. Coordinates with the patient care team to review clinic appointment availability utilization to ensure that clinic schedules are ... into VISTA if applicable. Promotes Veterans registration for and utilization of MyHealthyVet (MHV) and kiosks usage. Follows procedures...and the flexible use of a wide range of clinical flow processes relating to access to care… more
- CVS Health (Tallahassee, FL)
- …providers. As a Medical Director you will + Focus primarily on overseeing utilization review / quality assurance and be responsible for predetermination reviews ... transparent and consumer-focused, and it recognizes physicians for their clinical quality and effective use of health care... clinical quality and effective use of health care resources. In the Medical Director role you will… more
- University of Miami (Fort Lauderdale, 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) . Core Job Summary:… more
- CVS Health (Tallahassee, FL)
- …transferring patients to lower levels of care . + 1+ years' experience in Utilization Review . + CCM and/or other URAC recognized accreditation preferred. + 1+ ... self-insured clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures… more