- MTC (Graceville, FL)
- …improvement committee. 7. Closely monitor all potential catastrophic events and perform utilization review and tracking. 8. Submit and implement recommendations ... Monitor delivery of mental health care, audit patient records, review and complete monthly statistical reports, analyze, distribute, and...for improvements in services and optimal utilization of staff. 9. Develop and monitor effectiveness of… more
- Travelers Insurance Company (Tallahassee, FL)
- …which can impact claim outcomes. Organize and coordinate Travelers' medical review functions. This includes interpreting Federal and State regulations and medical ... guidelines to establish medical review policies. Works in close collaboration with the Claim...Have?** + Licensed MD + 5 years clinical and utilization management experience + Certified by the American Board… more
- MTC (Quincy, FL)
- …the duties of the position. 11. Practice advanced cost containment and utilization management for inmate care and facility operations. 12. Maintain absolute security ... and confidentiality of all medical records; observes applicable HIPAA rules. 13. Review medical files to determine all provided services are documented. 14. Closely… more
- BAYADA Home Health Care (Orlando, FL)
- …+ Candidates should be available Monday-Friday from 8:30am-5:00pm. _Medicare, Coder, OASIS Review , Utilization Review , Quality Assurance, Remote, Home Health ... Home Health Care is hiring a full time OASIS Review and Coding Manager. The OASIS and Coding ...productivity maintained at the quarterly target set by the Director of MCM. + Prevent or decrease the occasion… more
- BAYADA Home Health Care (Orlando, FL)
- …your career with an industry leader. Apply now for immediate consideration. OASIS Review , Utilization Review , Quality Assurance, Remote, Home Health Coding, ... immediate opening for a **Full Time,** OASIS and Coding Review Manager with OASIS and Coding certification to work...productivity maintained at the quarterly target set by the Director of MCM. + Prevent or decrease the occasion… more
- ChenMed (Pembroke Pines, FL)
- …engagement with patient and family. + Facilitate patient/family conferences to review treatment goals, optimize resource utilization , provide family education ... assist in achieving desired clinical outcomes within specific timeframe. + Conducts review for appropriate utilization of services from admission through… more
- CenterWell (The Villages, FL)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... delivery, and documentation requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking for performance … more
- HCA Healthcare (Port St. Lucie, FL)
- …a data-driven environment of quality and cost improvement and develops systems to review utilization of resources and objectively measure outcomes of care in ... for appeals and denials process, discharge planning, case management, and utilization review /management. + Consults with facility-level staff regarding delegated… more
- Highmark Health (Tallahassee, FL)
- …drug utilization reports, and write drug monographs for Committee review to develop the Organization's Drug formulary and/OR provide recommendations for NDC ... improvements to maximize overall efficiencies. + Manage individual projects for timely review with the Director , Clinical Pharmacy. + Participate in Medicare… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …+ Participate in interdisciplinary case rounds, quality improvement initiatives, and utilization review processes. + Support members during transitions of ... the requested level of care/patient status to the Medical Director . + Proactively identifies and resolves delays and obstacles...+ Experience in a managed care, case management, or utilization review setting + Strong understanding of… more