- Cleveland Clinic (Port Saint Lucie, FL)
- …the implementation of annual program promotion and awareness activities to meet utilization targets. + Provides clinical services for individuals, couples and ... to these duties, the role includes crisis intervention, assessment, case management, referral services, and brief solution-focused counseling. While counseling… more
- Humana (Hallandale Beach, FL)
- …the period of this unpaid internship, you will work with the Medicaid Clinical Services team to ensure interaction between the company and members are optimized. ... The Telephonic Behavioral Health Care Manager Internship provides transitioning service members that are eligible...psycho-social health issues. + Monitor and maintain awareness of utilization and conducts outreach based on acuity to assess… more
- AdventHealth (Land O' Lakes, FL)
- …patient care outcomes within effective time frames on a specific group of patients.The Case Manager is responsible for utilization reviews and resource ... South University with staff discounted rate .Simulation Lab and Clinical Transition Pilot Program .Free prep courses for national...Awards, TWCE as Nice The role you'll contribute: The Case Manager is accountable for the organization,… more
- AdventHealth (Palm Coast, FL)
- …: **Location:** **The role you'll contribute:** The Home Health Physical Therapist (PT) Case manager is a professional therapist who coordinates and directs the ... home care patient's services based on individual patient needs. The PT Case manager is responsible for independent management of the Home Health patient… more
- Evolent (Tallahassee, FL)
- …and staff whenever a physician`s input is needed or required. Responsible for clinical audits for quality and education regarding the results and monitoring for ... Responsible for coordinating education and findings with matrixed Physician Business Manager . + Provides medical direction to the support services review process.… more
- Elevance Health (Tampa, FL)
- …work East Coast time zone hours.** The **Medical Director** will be responsible for utilization review case management for Commercial business in the New England ... with providers and external physicians. + May conduct peer-to-peer clinical appeal case reviews with attending physicians...state or territory of the United States when conducting utilization review or an appeals consideration and cannot be… more
- Elevance Health (Miami, FL)
- …office visits with providers and external physicians. + May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering ... manager . + May be responsible for an entire clinical program and/or independently perform clinical reviews....state or territory of the United States when conducting utilization review or an appeals consideration and cannot be… more
- Elevance Health (Tampa, FL)
- …or case management experience and requires a minimum of 2 years clinical , utilization review, or managed care experience; or any combination of education ... require nursing judgment, critical thinking, and holistic assessment of member's clinical presentation to determine whether to approve requested service(s) as… more
- Molina Healthcare (St. Petersburg, FL)
- …Certified Clinical Coder, Certified Medical Audit Specialists, Certified Case Manager , Certified Professional Healthcare Management, Certified Professional ... for denial or modification of payment decisions. + Serves as a clinical resource for Utilization Management, Chief Medical Officers, Physicians, and… more
- CenterWell (Jacksonville, FL)
- …leading clinical performance in patient experience, quality of care, clinical outcomes, and avoidable utilization + Periodically review clinician charts ... precise + Identify critical issues for high-risk patients during case reviews & other forums, and modeling and driving...(HRPM), and social determinants of health (SDOH) efforts, improving clinical outcomes and avoidable utilization + Monitor… more