- MyFlorida (Orlando, FL)
- …members, co-workers and community partners. Ability to use computer systems. Ability to review compliance of foster care providers' licensed capacity. Ability to ... for licensure to supervisor/regional program manager. + Investigates complaints on licensed providers and illegal child care operations. Prepares reports and… more
- Humana (Tallahassee, FL)
- …for review depending on case findings. Educates providers on utilization and medical management processes. + Enters and maintains pertinent clinical information ... your skills to make an impact** **Required Qualifications** + Licensed Registered Nurse (RN) in either Florida or a...Utilization Management (UM), Pre-Auth, and/or other managed care review experience. + 1+ years of acute and/or critical… more
- HCA Healthcare (Gainesville, FL)
- …physical, psycho-social, financial). 1. Participates in IDT rounds, 1. Conducts utilization review , evaluates clinical information, and communicates findings to ... physicians and payors on a timely basis in accordance with the NFRMC Utilization Review Plan and managed care contractual agreements. 1. Submits clinical… more
- HCA Healthcare (Fort Walton Beach, FL)
- …guidelines. Participates in developing department goals and clinical programming. + Performs utilization review as assigned. + Helps with Process and Quality ... start date + Other-Fingerprint Required + Masters Degree + Licensed Clinical Social Worker (LCSW), or Licensed ...+ Licensed Clinical Social Worker (LCSW), or Licensed Family Therapist (LFT), or Licensed Mental… more
- YesCare Corp (Tallahassee, FL)
- …measures including sentinel event review + Actively participant of the Utilization Review process and follow proper procedures. + Follows standard ... + Graduate of an accredited medical school. + Fully licensed to practice medicine in the state of employment...staff. + Ensure and provide on-call services. + Annually review and approve clinical protocols, policies and procedures, and… more
- CVS Health (Tallahassee, FL)
- …with transferring patients to lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC recognized accreditation preferred. + ... AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support… more
- BAYADA Home Health Care (Jacksonville, FL)
- …including admission rates, re-hospitalizations, visit productivity, and clinician utilization . + Collaborate with referral sources, physicians, hospitals, and ... community partners to support business development partners and census growth. + Review and manage key financial indicators including PDGM performance, LUPAs, visit … 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 ... is a proud member of Elevance Health's family of brands. We are a licensed health maintenance organization with health plans for people enrolled in Medicaid and/or… more
- KBR (Elgin AFB, FL)
- …the development and utilization of required databases. + Conduct peer (record) review s for the HP Staff as directed by governing credentialing body and local ... evaluation, treatment, and rehabilitation of musculoskeletal conditions. They are licensed independent practitioners and credentialed as direct care providers in… more
- HCA Healthcare (Pensacola, FL)
- …while supporting a balance of optimal care and appropriate resource utilization . Identify potential barriers to patient throughput and quality outcomes and ... processes, for the appropriate level of care, patient status, and resource utilization . + Conducts interdisciplinary team meetings to provide a mechanism for all… more