- Humana (Tallahassee, FL)
- …explain the rationale behind utilization management decisions, + Work includes computer- based review of moderately complex to complex clinical scenarios, ... least 2 years of experience post-training providing clinical services . Experience in utilization management review and case management in a health plan setting… more
- ChenMed (Lakeland, 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 ... conferences to review treatment goals, optimize resource utilization , provide family education and identify home ...patients' progress and adjust and plan accordingly. + Understanding utilization review and how to leverage with… more
- Evolent (Tallahassee, FL)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... the mission. Stay for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to make a… more
- HCA Healthcare (Tallahassee, 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
- HCA Healthcare (Panama City, 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 ... support for appeals and denials process, discharge planning, case management, and utilization review /management + You will consult with facility-level staff… more
- Molina Healthcare (Tampa, FL)
- … management, risk management, risk adjustment, disease management, and evidence- based guidelines. + Experience in Utilization /Quality Program management ... and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource… more
- Molina Healthcare (Jacksonville, FL)
- … management, risk management, risk adjustment, disease management, and evidence- based guidelines. + Experience in Utilization /Quality Program management ... and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource… more
- Evolent (Tallahassee, FL)
- …a profound impact on the lives of our members. **What you'll be doing:** Utilization Management + Supports pre-admission review , utilization management, and ... review process. + Participates in risk management, claim adjudication, pharmacy utilization management, catastrophic case review , outreach programs, + Assists… more
- Evolent (Tallahassee, FL)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... Director you will be a key member of the utilization management team. We can offer you a meaningful...the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
- CenterWell (Tallahassee, FL)
- …consistent and standardized program workflows, dyad communication/partnership, and quarterly business review of acute care and post-acute care utilization . + ... and coordinating care to reduce acute and post-acute care utilization . The Divisional Director role is a hybrid with...organization. This must include the ability to drive a team- based approach and work as an interdisciplinary team to… more
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