- HCA Healthcare (Gainesville, FL)
- …physical, psycho-social, financial). 1. Participates in IDT rounds, 1. Conducts utilization review , evaluates clinical information, and communicates findings to ... Florida Hospital team is looking for a(an) Manager Case Management . HCA Healthcare is an advanced healthcare network that...on a timely basis in accordance with the NFRMC Utilization Review Plan and managed care contractual… more
- ChenMed (North Miami Beach, FL)
- …of 2 years' clinical work experience required. + A minimum of 1 year of utilization review and/or case management , home health, hospital discharge planning ... assess and record patients' progress and adjust and plan accordingly. + Understanding utilization review and how to leverage with inpatient staff for possible… more
- AdventHealth (Orlando, FL)
- …appeals for denials. Provides guidance to clinical questions from Utilization Management staff involved in authorizations, concurrent review , and denials as ... and serves as a resource to Medical Staff colleagues regarding best practices, Utilization Management and Care Management structures, and functions and… more
- Evolent (Tallahassee, FL)
- …sources to establish and maintain the definitive source of truth for specialty Utilization Management (UM) agreements. This important work is achieved through ... Minimum 3 years of professional experience in value-based healthcare analytics or utilization management within a payer, provider, clinical vendor, managed care,… more
- CenterWell (Deland, 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
- Elevance Health (Tampa, FL)
- …or equivalent. + Requires a minimum of 2 years of clinical experience and/or utilization review experience. + Current active, valid and unrestricted LPN/LVN or ... in multiple states. **Preferred Skills, Capabilities and Experience:** + Experience in Utilization Management and/or Long Term Care Services Strongly Preferred.… more
- HCA Healthcare (Gainesville, FL)
- …issues. Offers clinical support for appeals and denials process, discharge planning, case management , and utilization review / management . + Consults with ... of quality and cost improvement and develops systems to review utilization of resources and objectively measure...facility-level staff regarding delegated utilization management and disease management operations under managed… more
- Highmark Health (Tallahassee, FL)
- …Organization's Formularies, utilization management programs, and disease management initiatives. + Provide clinical review and decisions including but ... . + Assist in the development and implementation of utilization management programs including but not limited...maximize overall efficiencies. + Manage individual projects for timely review with the Director , Clinical Pharmacy. +… more
- HCA Healthcare (Ocala, FL)
- …the areas of critical thinking, interpersonal relationships, and technical skills. + Review non-formulary requests and provide overall formulary management for ... safe, and economical patient care. Advanced Clinical Pharmacist will assist the Director of Pharmacy and Clinical Manager in the development of Pharmacy clinical… more
- AdventHealth (Port Charlotte, FL)
- …under the general supervision of the Care Managment Supervisor or Manager or Director of Nursing and is responsible for patient evaluations of post-hospital needs; ... patient satisfaction, patient safety, readmission prevention and length of stay management . The RN Care Manager communicates daily with the interdisciplinary team… more