- Molina Healthcare (Tampa, FL)
- …and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina Healthcare ... members. + Processes requests within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests additional information… more
- Molina Healthcare (Jacksonville, FL)
- …and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina Healthcare ... members. + Processes requests within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests additional information… more
- Monte Nido (Miami, FL)
- …the opportunity for people to realize their healthy selves. **Utilization Review Clinician ** **Monte Nido** **Remote** **Monte Nido has been delivering treatment for ... care within an intimate home setting. We are seeking a Utilization Review Clinician to join our team based Remotely. **This is a Full-Time remote position… more
- WelbeHealth (Hollywood, FL)
- …focus lead the way no matter what. The Licensed Mental Health Clinician (internally known as Behavioral Health Specialist) works alongside the Social Work ... and proof of vaccination, or a vaccine declination form will be required prior to employment. WelbeHealth maintains required infection control and PPE standards and… more
- Molina Healthcare (FL)
- …and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina Healthcare ... members. + Processes requests within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests additional information… more
- Molina Healthcare (Jacksonville, FL)
- …a compact licensure. The ideal candidate will have experience with UM and prior authorization, within both Physical Health and Behavioral Health. Candidates with a ... and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina Healthcare… more
- Molina Healthcare (Miami, FL)
- …financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed. + Processes requests ... **Preferred Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual /… more
- Molina Healthcare (Miami, FL)
- …financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed. + Processes requests ... within required timelines. + Refers appropriate cases to Medical Directors and presents them in a consistent and efficient manner. + Requests additional information from members or providers in consistent and efficient manner. + Makes appropriate referrals to… more
- Centene Corporation (Tallahassee, FL)
- …(BH) and/or autism spectrum disorder needs and clinical standards + Performs prior authorization reviews related to BH to determine medical appropriateness in ... accordance with ABA regulatory guidelines and criteria + Analyzes BH member data to improve quality and appropriate utilization of services + Interacts with BH healthcare providers as appropriate to discuss level of care and/or services provided to members… more
- Centene Corporation (Tallahassee, FL)
- …to ensure level of care and services are medically appropriate + Performs prior authorization reviews related to mental health and substance abuse to determine ... medical appropriateness in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine overall health of member, treatment needs, and discharge planning + Analyzes BH member data to improve… more