- AdventHealth (New Smyrna Beach, FL)
- …patient satisfaction, patient safety, readmission prevention and length of stay management . The RN Care Manager communicates daily with the interdisciplinary team ... core competencies of this role. The RN Care Manager facilitates the collaborative management of patient care across the continuum, intervening to remove barriers to… more
- AdventHealth (Zephyrhills, FL)
- …patient satisfaction, patient safety, readmission prevention and length of stay management . The RN Care Manager communicates daily with the interdisciplinary team ... core competencies of this role. The RN Care Manager facilitates the collaborative management of patient care across the continuum, intervening to remove barriers to… more
- Molina Healthcare (Tampa, FL)
- …outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases ... Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + Identifies and reports… more
- AdventHealth (Orlando, FL)
- …patient satisfaction, patient safety, readmission prevention and length of stay management . The RN Care Manager communicates daily with the interdisciplinary team ... core competencies of this role. The RN Care Manager facilitates the collaborative management of patient care across the continuum, intervening to remove barriers to… more
- AdventHealth (Port Charlotte, FL)
- …patient satisfaction, patient safety, readmission prevention and length of stay management . The RN Care Manager communicates daily with the interdisciplinary team ... core competencies of this role. The RN Care Manager facilitates the collaborative management of patient care across the continuum, intervening to remove barriers to… more
- AdventHealth (Ocala, FL)
- …(FPPE) functions in accordance with The Joint Commission (TJC) Standards, CMS Conditions of Participation, Medical Staff Bylaws and Professional Practice Evaluation ... Policy. This includes the analysis of events that require peer review and the examination of medical records as identified by clinical indicators or triggers is an integral part of this role. The Coordinator Professional Practice Evaluation is responsible for… more
- CenterWell (Tallahassee, FL)
- …in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part ... clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work… more
- AdventHealth (Altamonte Springs, FL)
- **GENERAL SUMMARY** **:** The Vice President of Quality serves as the health system expert and executive sponsor with responsibility for developing and executing a ... comprehensive quality management program that drives high-value care to achieve clinical...Medical Group to align specialty physician performance with health system strategic priorities to achieve organizational goals. Partners with… more
- Fresenius Medical Center (Trenton, FL)
- …effective dialysis therapy for patients under the direct supervision of a licensed nurse in accordance with FMCNA policies procedures and training and in compliance ... last treatment. Report any complaints or observations to the nurse supervisor. + Evaluate vascular access for patency and...testing including Pressure Holding (PHT). + Initiate Solution Delivery System (SDS) system . + Ensure that all… more
- Humana (Tallahassee, FL)
- …you will be a key enterprise leader, with responsibility for evolving Humana's Utilization Management of medical review by physician or nurse , with a focus on ... To succeed in this position, you will need to be well versed in CMS knowledge of outpatient, inpatient and appeal criteria including regulation and policies. You… more