- CVS Health (Tallahassee, FL)
- …and consistent responses to members and providers. Leads all aspects of utilization review/quality assurance, directing case management Provides clinical ... the US.** Aetna, a CVS Health Company, has an exciting opportunity for a Medical Director (Spine) that can be remote based, work from home. The Medical Director … more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …Nurse in the State of Florida. + 3 years minimum experience in discharge planning, utilization management , or case management . + Basic proficiency in ... healthcare needs of the patients using the functions of Utilization Resource Management , Transition of Care, Discharge Planning, and Case Management . +… more
- AdventHealth (Orlando, FL)
- …each position may vary based on geographical location. **Category:** Case Management **Organization:** AdventHealth Orlando **Schedule:** Full-time **Shift:** ... Supervisor is under the general leadership of the Care Management Manager or Facility Director and assists...minimizes unscheduled absences + Plans job responsibilities for maximum utilization of staff + Resolves daily staffing issues **The… more
- Elevance Health (Miami, FL)
- …critical thinking skills and nursing judgment and experience. + Collaborates with case management nurses on discharge planning, ensuring patient has appropriate ... treatment is medically necessary and provides consultation to Medical Director on cases that are unclear or do not...about plan benefits and physicians and may assist with case management . + Collaborates with leadership in… more
- Sevita (Lecanto, FL)
- …DSPs in documenting incident reports; submits initial incident reports to the Program Director . 8. Billing and Utilization : Compiles or accumulates census or ... on a daily basis; maintains 3. Program Planning: Assists the Program Director in development of individual program plans; trains and monitors implementation of… more
- HCA Healthcare (Bradenton, FL)
- …care issues. Offers clinical support for appeals and denials process, discharge planning, case management , and utilization review/ management . + Consults ... with facility-level staff regarding delegated utilization management and disease management operations under managed...the denial and appeals process, as requested by the Case Management Department and Patient Accounting Services.… more
- CenterWell (Lake City, FL)
- …performance review and outcomes of care analysis to determine efficiency, the efficacy of case management system as well as any other systems and process. ... the delivery of care to all patients served by the location. Receives case referrals. Reviews available patient information related to the case , including… more
- Community Health Systems (Naples, FL)
- …**Qualifications** + 2-4 years of clinical nursing experience required + Experience in utilization review, case management , or discharge planning preferred ... **Job Summary** The Care Manager - LPN supports effective utilization management and discharge planning by coordinating...Knowledge of federal, state, and accreditation standards related to case management and patient care. + Excellent… more
- AdventHealth (Palm Coast, FL)
- …of Nursing. + Health-related Master's degree or MSN. + Prior Care Management / Utilization Management experience. + ACM/CCM Certification. This facility ... for each position may vary based on geographical location. **Category:** Case Management **Organization:** AdventHealth Palm Coast **Schedule:** Per Diem… more
- AdventHealth (Palm Coast, FL)
- …+ Social Worker: BSW Masters in related field + 3 years in direct Care Management / Utilization Management experience in an acute care setting. + State ... for each position may vary based on geographical location. **Category:** Case Management **Organization:** AdventHealth Palm Coast **Schedule:** Full-time… more