- Evolent (Tallahassee, FL)
- …focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and procedures ... work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators...Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
- Humana (Tallahassee, FL)
- …this knowledge in their daily work. The Medical Director's work includes computer- based review of moderately complex to complex clinical scenarios, ... with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health… more
- Humana (Tallahassee, FL)
- …this knowledge in their daily work. The Medical Director's work includes computer- based review of moderately complex to complex clinical scenarios, ... with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health… more
- Humana (Tallahassee, FL)
- …this knowledge in their daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, review ... with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health… more
- HCA Healthcare (Gainesville, FL)
- …is preferred . BSN is preferred . Certification in Case Management, Nursing or Utilization Review is preferred HCA Florida North Florida Hospital is a 523-bed, ... 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
- AdventHealth (Orlando, FL)
- …to nurses, physicians and the interdisciplinary team on issues related to utilization of resources, medical necessity, CMS CoP for Discharge Planning and care ... available to the patient including, but not limited to the following: Home Health, Infusion Services, Durable Medical Equipment, Palliative Care, Hospice, Outpatient… more
- HCA Healthcare (Gainesville, FL)
- …is preferred + BSN is preferred + Certification in Case Management, Nursing or Utilization Review is preferred HCA Florida North Florida Hospital is a 523-bed, ... 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
- Ascension Health (Jacksonville, FL)
- …your community _Benefit options and eligibility vary by position. Compensation varies based on factors including, but not limited to, experience, skills, education, ... recent work experience in a hospital setting, preferably with some Physician Advisory/ Utilization Management work experience. If you are ready to join a talented… more
- Molina Healthcare (St. Petersburg, FL)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + Identifies and… more
- HCA Healthcare (Fort Pierce, FL)
- …2 years of critical care experience + Certification in case management or utilization review preferred + InterQual experience preferred HCA Florida Lawnwood ... 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