- Molina Healthcare (Tampa, FL)
- …Care Access and Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/ utilization review , and/or other utilization ... + Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of InterQual / MCG guidelines.… more
- Monte Nido (Miami, FL)
- …authorization, potential denials, and potential for private payment. + Follow workflow and medical record requirements for utilization review and clinical ... while providing the opportunity for people to realize their healthy selves. ** Utilization Review Clinician** **Monte Nido** **Remote** **Monte Nido has been… more
- DOCTORS HEALTHCARE PLANS, INC. (Miami, FL)
- …are a plus. Experience: + Minimum 5-10 years of progressively responsible experience in medical management, or utilization review within a healthcare plan, ... responsible for the strategic direction, leadership, and oversight of all medical management functions, including Utilization Management, and Quality Improvement… more
- Centene Corporation (Tallahassee, FL)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering… more
- BayCare Health System (Tampa, FL)
- …foundation of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior responsibilities include:** + Functions ... to ensure appropriate level of care through comprehensive concurrent review for medical necessity of outpatient observation...Nursing or Business **Experience:** + Required 2 years in Utilization Review or + Required 2 years… more
- BayCare Health System (Clearwater, FL)
- …foundation of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior responsibilities include:** + Functions ... to ensure appropriate level of care through comprehensive concurrent review for medical necessity of outpatient observation...Nursing or Business **Experience:** + Required 2 years in Utilization Review or + Required 2 years… more
- Centene Corporation (Tallahassee, FL)
- …assess ABA Treatment Plans required. Knowledge of ABA services and BH utilization review process required. Experience working with providers and healthcare ... for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering… more
- Humana (Tallahassee, FL)
- …nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization ... and independent determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent… more
- Actalent (Sunrise, FL)
- …UMN assists in complex cases, develops internal processes, and educates physicians on utilization review issues. The role involves managing continuity of care, ... satisfaction, safety, and appropriate length of stay. Responsibilities + Review prior authorization requests for medical necessity...on department activities as assigned. Essential Skills + Clinical review + Utilization review +… more
- Centene Corporation (Tallahassee, FL)
- … management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , ... with respect to clinical issues and policies. + Identifies utilization review studies and evaluates adverse trends... review studies and evaluates adverse trends in utilization of medical services, unusual provider practice… more