- ChenMed (Opa Locka, FL)
- …in achieving desired clinical outcomes within specific timeframe. + Conducts review for appropriate utilization of services from admission through discharge. ... with patient and family. + Facilitates patient/family conferences to review treatment goals and optimize resource utilization ;...clinical and progress notes for each patient receiving care and provides progress report to PCP and others… more
- AdventHealth (Daytona Beach, FL)
- …is responsible for alerting leadership of potential discrepancies in documentation or clinical care variation as part of ongoing performance improvement. ... Data Systems (FCDS).The ODS-C is responsible for ensuring all clinical elements accurately reflect the care provided...training as appropriate. + Participates in Quality Assurance peer review , as a reviewer and reviewee. Timely… more
- Humana (Tallahassee, FL)
- …insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review organization, ... daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical ...region or line of business. The Medical Director conducts Utilization Management of the care received by… more
- Sedgwick (Tallahassee, FL)
- …related line of business experience in telephonic case management (TCM) and/or utilization review or equivalent combination of education and experience required. ... Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Quality Review Nurse **PRIMARY PURPOSE** : To monitor team and colleague technical and… more
- Actalent (Sunrise, FL)
- …+ Prepare and present reports on department activities as assigned. Essential Skills + Clinical review + Utilization review + Utilization ... or LPN License. + Minimum of one year of utilization review experience and discharge planning in an acute care setting. + Four years of related clinical … more
- Florida Health Care Plans, Inc. (Daytona Beach, FL)
- …emotional factors underlying patient's health problem. ? Monitors ongoing training, utilization review and peer review for clinical Providers within the ... Summary Florida Health Care Plans, a large multi-specialty staff model HMO...Attends required in-service, departmental and organizational meetings. Participates in clinical review of cases. Requirements ? MD… more
- AdventHealth (Orlando, FL)
- …Manager ensures efficient and cost-effective care through appropriate resources monitoring, and clinical care escalations. The RN Care Manager is under ... destination and updates, as needed. Actively participates in daily Multidisciplinary Rounds to review progression of care and discharge plan for all assigned… more
- BayCare Health System (Sarasota, FL)
- …the area of responsibility. + Ensure quality assurance program and utilization review is followed in accordance with Home Care protocol. + Oversees and ... on a foundation of trust, dignity, respect, responsibility and clinical excellence. BayCare HomeCare nurses make a difference in...Case Manager on initial Plan of Care review with a focus on quality, utilization … more
- CVS Health (Tallahassee, FL)
- …ourselves with dedicated colleagues who are passionate about transforming health care . As the nation's leading health solutions company, we reach millions ... every day. **Position Summary** Help us elevate our member care to a whole new level! Join our Aetna...serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our… more
- Molina Healthcare (FL)
- …adjustment, disease management, and evidence-based guidelines. + Experience in Utilization /Quality Program management + HMO/Managed care experience **PREFERRED ... national, state, and local laws and regulatory requirements affecting the medical and clinical staff. MD licenses required for the following states: WA, FL, MI, MS,… more