- ChenMed (Tamarac, FL)
- …to ensure compliance with guidelines along with participating in risk and quality management programs, clinical meetings and other meetings as required. The PCP ... Rate Advance directives/End of Life Planning Patient Satisfaction Utilization/Financial Management -managing resource utilization and reimbursement for services.… more
- CVS Health (Tallahassee, FL)
- … skills to coordinate, document and communicate all aspects of the utilization/benefit management program. + Utilizes clinical experience and skills in a ... Monday-Friday.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health....support cost-effective quality care for members. + Work in clinical telephone queue for 3 to 4 hours a… more
- University of Miami (Miami, FL)
- …evidenced-based research and national standards. + Consults with and serves as a clinical resource for unit management to ensure quality patient ... + Contribute to the preparation of multimedia learning packages + Use multimedia learning resources + Make appropriate use of clinical simulators + Evaluate and… more
- CVS Health (Coral Gables, FL)
- …Services and strategies, policies and programs are comprised of network management , clinical coverage, and policies. **Position Summary/Mission** Community Care ... needs and benefit plan eligibility and facilitates integrative functions using clinical tools and information/data. + Utilizes case management processes… more
- Humana (Tallahassee, FL)
- …of the managed care industry, Integrated Delivery Systems, health insurance, or clinical group practice management + Utilization management experience ... put health first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D...complex to complex appeals for coverage for drugs using resources outlined above as well as inter- and intra-departmental… more
- ChenMed (Largo, FL)
- …education patient may need and to oversee appropriate patient discharge from case management . + Performs clinical , fall prevention, and social determination of ... members of the care team that provides hyperfocus case management and field nursing interventions to prevent unnecessary hospital...The Intensive Community Managers (ICCMs) will serve as a clinical lead for the Complex Care Team. They will… more
- AdventHealth (Tampa, FL)
- …Utilization Management , the Physician Advisor is responsible for providing clinical review of utilization, claims management , and quality assurance related ... medical care. **The value you'll bring to the team** **:** Provides clinical support/validation for both Utilization Management and Care Management… more
- AdventHealth (Deland, FL)
- …patient care unit and for the day-to-day management and supervision of related clinical activities to which assigned. The RN Resource uses the nursing skills ... Program* (For eligible positions) + Career Development + Whole Person Wellbeing Resources + Referral Bonus $2500 and Relocation Bonus $3000 **Our promise to… more
- Sedgwick (Orlando, FL)
- …is disabled as defined by the disability plan. + Utilizes the appropriate clinical resources in case assessment (ie duration guidelines, in-house clinicians). + ... + Refers cases as appropriate to team lead and clinical case management . + Maintains professional client...appropriate to team lead and clinical case management . + Maintains professional client relationships. **ADDITIONAL FUNCTIONS and… more
- Sedgwick (Orlando, FL)
- …accommodations, and claims outside of typical guidelines. + Utilizes the appropriate clinical resources in case assessment (ie duration guidelines, in-house ... physician and employer. + Refers cases to team lead and clinical case management for additional review when appropriate. + Maintains professional client… more