- Evolent (Tallahassee, FL)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... Radiology you will be a key member of the utilization management team. We can offer you a meaningful...rationale for standard and expedited appeals. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
- Evolent (Tallahassee, FL)
- …business needs of the particular health plan. * Research requests for post-determination review and categorizes each for processing based on the applicable ... You Bring:** + 1-3 years' experience in clinical Appeals Review or Utilization Management Review ...all employees have the following technical capability at their home : High speed internet over 10 Mbps and, specifically… more
- HCA Healthcare (Sunrise, FL)
- …protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, ... a 100% match on 3% to 9% of pay ( based on years of service) + Employee Stock Purchase...+ Referral services for child, elder and pet care, home and auto repair, event planning and more +… more
- HCA Healthcare (Gainesville, FL)
- …physical, psycho-social, financial). + Participates in IDT rounds, + Conducts utilization review , evaluates clinical information, and communicates findings to ... what matters most to nurses like you - at home , at work, and at every stage in your...on a timely basis in accordance with the NFRMC Utilization Review Plan and managed care contractual… more
- HCA Healthcare (Tallahassee, FL)
- …required within 30 days of start + Certification in Case Management, Nursing, or Utilization Review , preferred + Three years of nursing experience in acute care ... protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care...a 100% match on 3% to 9% of pay ( based on years of service) + Employee Stock Purchase… more
- Actalent (Gainesville, FL)
- …services and care. + Participate in interdisciplinary team rounds. + Conduct utilization review , evaluate clinical information, and communicate findings to ... physicians and payors in accordance with utilization review plans and managed care agreements. + Submit clinical information to insurance companies to ensure all… more
- Anywhere Real Estate (Tampa, FL)
- …product managers, engineers, and business owners to ensure effective management and utilization of knowledge assets. You will ensure that Anywhere maintains the ... Oversee all stages of the knowledge management lifecycle, including creation, review , publication, and retirement of knowledge assets. + **Collaboration:** Partner… more
- HCA Healthcare (Lake City, FL)
- …your knowledge and expertise! **Job Summary and Qualifications** Provides hospital case management/ utilization review and discharge planning to assure that the ... experience in case management and/or supervisory/management position involving case management/ utilization review /responsibility in an acute care hospital and/or… more
- AdventHealth (Maitland, FL)
- …management, involving physicians and multiple hospital departments, to assure appropriate utilization of hospital resources, appropriate level of care for patients, ... discharge planning. Responsible for assuring appropriateness of patient admissions based on severity of illness/intensity of service criteria. Facilitates case… more
- Evolent (Tallahassee, FL)
- …description: As a Clinical Reviewer, Nurse, you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in ... You Will Be Doing:** + Functions in a clinical review capacity to evaluate all cases, which do not...are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts and analyzes… more
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