- Elevance Health (Tampa, FL)
- …Prepares reports and documents all actions. + Responsibilities exclude conducting any utilization management review activities which require interpretation ... area to refer or assign case ( utilization management , case management , QI, Med Review...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- AdventHealth (Port Charlotte, FL)
- …transitions, patient satisfaction, patient safety, readmission prevention and length of stay management . The RN Care Manager communicates daily with the ... are core competencies of this role. The RN Care Manager facilitates the collaborative management of patient...physicians and the interdisciplinary team on issues related to utilization of resources, medical necessity, CMS CoP for Discharge… more
- AdventHealth (Riverview, FL)
- …transitions, patient satisfaction, patient safety, readmission prevention and length of stay management . The RN Care Manager communicates daily with the ... are core competencies of this role. The RN Care Manager facilitates the collaborative management of patient...physicians and the interdisciplinary team on issues related to utilization of resources, medical necessity, CMS CoP for Discharge… 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
- Evolent (Tallahassee, FL)
- …the support services review process. Responsible for the quality of utilization review determinations, including appeals. + Provides input into audit ... member of the Medical leadership team, providing timely medical review of service requests. Oversees the Surgery Field Medical...needed for new hires to educate and train on Utilization management system and Field Medical Director… more
- Elevance Health (Miami, FL)
- …or case management experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or any combination of education and ... - 6pm EST and will include weekends. The **Medical Management Nurse** will be responsible for review ...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Highmark Health (Tallahassee, FL)
- …Organization's Formularies, utilization management programs, and disease management initiatives. + Provide clinical review and decisions including but ... utilization reports, and write drug monographs for Committee review to develop the Organization's Drug formulary and/OR provide.... + Assist in the development and implementation of utilization management programs including but not limited… more
- Sharecare (Tallahassee, FL)
- …change techniques, the nurse helps to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is ... disease management program intervention guidelines. A Disease Management Nurse is supervised by an Operations Manager...and to take the pre and post tests to review competency during orientation. Yearly competency tests are required… more
- CVS Health (Tallahassee, FL)
- …- Emergency/critical care experience - Experience working Grievance cases - Case Management or Utilization Management experience - Managed care ... This position reports to the Potential Quality of Care (PQOC) nurse investigator team manager . This position is responsible for the review and evaluation of… more
- Cherry Bekaert (Fort Lauderdale, FL)
- …Resource Coordinator will effectively fill resource engagement requests overseeing the utilization of resources, ensuring alignment of resources with the strategic ... that develop within the area. You will continuously communicate with management regarding future needs versus availability, potential staffing issues, and other… more