- Molina Healthcare (St. Petersburg, FL)
- …preferred. **Preferred Experience** 3-5 years clinical practice with managed care , hospital nursing, utilization and/or care management experience. ... role must complete courses required to obtain licensure in all states. + Utilization Review Lead responsibilities also include but not limited to, collaborate… more
- Community Health Systems (Naples, FL)
- …Medical Record + Works with healthcare providers to ensure complete and accurate condition and care of the patient + Serves as a resource to support the UR team in ... improvement programs + Addresses facility and departmental communication through daily review of all correspondence, including incoming email messages. + Performs… more
- Humana (Tallahassee, FL)
- …Qualifications:** + Experience in managed care pharmacy, particularly in utilization management review **Additional Information:** **Interview Format** : ... part of our caring community and help us put health first** The Staff Utilization Management Pharmacist is a clinical expert responsible for conducting medical… more
- AdventHealth (Tampa, FL)
- …for escalation to the Physician Advisor or designated leader for additional review as determined by department standards. The Utilization Management Nurse ... AdventHealth Division AdventHealth Tampa, a faith-based not-for-profit 626-bed tertiary-level acute care hospital located in the uptown district of Tampa, Florida,… more
- AdventHealth (Tampa, FL)
- …reviews within 24 hours of admission; and when warranted by length of stay, utilization review plan, and/or best practice guidelines, on a continuing basis. ... also located at AdventHealth Tampa, leads the way in clinical and academic research in the areas of neuroscience,...Registered Nurse (RN) License Required. 1 years of critical care nursing experience preferred. 1 years of utilization… more
- CenterWell (Tallahassee, FL)
- …member service or customer service telephone experience desired + Experience with Utilization Review and/or Prior Authorization, preferably within a managed ... of our caring community and help us put health first** The Utilization Management (UM) Administrative Coordinator 2 is responsible for providing high-quality support… more
- CenterWell (Tallahassee, FL)
- … clinical RN experience; + Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + ... and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that… more
- Molina Healthcare (St. Petersburg, FL)
- …field, such as social work or clinical counselor (for Behavioral Health Care Review Clinicians only). **Required Experience** 1-3 years of hospital or ... LPCC or LMFT (for Behavioral Health Care Review Clinicians only). **Preferred Experience** 3-5 years clinical...Experience** 3-5 years clinical practice with managed care , hospital nursing or utilization management experience.… more
- BAYADA Home Health Care (Orlando, FL)
- …company match, direct deposit, and employee assistance program **Responsibilities:** + Review clinical information for appropriateness, congruency, and accuracy ... is no flexibility around this requirement.** BAYADA Home Health Care has an immediate opening for a **Full Time,**...an industry leader. Apply now for immediate consideration. OASIS Review , Utilization Review , Quality Assurance,… more
- BAYADA Home Health Care (Orlando, FL)
- …about BAYADA Benefits, click here (https://www.bayada.com/benefits/) . **Responsibilities:** + Review clinical information for appropriateness, congruency, and ... is no flexibility around this requirement.** BAYADA Home Health Care is hiring a full time OASIS Review...should be available Monday-Friday from 8:30am-5:00pm. _Medicare, Coder, OASIS Review , Utilization Review , Quality Assurance,… more