- CVS Health (Tallahassee, FL)
- …in Europe, APAC and Africa in support of an international network, medical cost management and overall claim/customer service strategies. This role will provide ... Risk Governance process for your assigned TPA(s). + Manage ongoing Aetna compliance review process for your assigned TPA(s). + Manage monthly billing / submission of… more
- AdventHealth (Deland, FL)
- …education to nurses, physicians and the interdisciplinary team on issues related to utilization of resources, medical necessity, CMS CoP for Discharge Planning ... discharge planning, transitions of care planning and understanding of medical necessity are core competencies of this role. The...(as permitted by the patient) as well as a review of the current and past inpatient and outpatient… more
- University of Miami (Miami, FL)
- …data, outliers, and corrective actions. + Monitor's product utilization and brings utilization issues to the attention of the Medical Director(s). + Analyzes ... faculty or staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The Department of… more
- University of Miami (Miami, FL)
- …case, including medical clearances and other steps based on the patient's medical condition. + OR Utilization - Ensures optimal use of designated operating ... faculty or staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The University of… more
- Molina Healthcare (Miami, FL)
- …clinical pharmacy services (such as, therapeutic drug monitoring, drug regimen review , patient education, and medical staff interaction), and oversight ... medication use policies). **KNOWLEDGE/SKILLS/ABILITIES** + Performs initial receipt and review of non-formulary or prior authorization requests against plan approved… more
- BayCare Health System (Bradenton, FL)
- …bodies within the area of responsibility. + Ensure quality assurance program and utilization review is followed in accordance with Home Care protocol. + ... amazing career growth opportunities. + Weekend shift differential + Medical benefits (Health, Dental, Vision) + Paid time off...Participates with Case Manager on initial Plan of Care review with a focus on quality, utilization … more
- Molina Healthcare (St. Petersburg, FL)
- …role must complete courses required to obtain licensure in all states. + Utilization Review Lead responsibilities also include but not limited to, collaborate ... timely completion. + Actively participates in the Department auditing program to review and communicate findings with staff and identify opportunities for improved… more
- MyFlorida (Tallahassee, FL)
- …present written analyses and reports relating to rates, budgets, and management/facility utilization . Ability to conduct research and review , analyze, evaluate, ... to Medicaid providers. This position is responsible for supervising the Graduate Medical Education Unit (GMEU) and the Supplemental Payments Unit (SPU) housed within… more
- HCA Healthcare (Kissimmee, FL)
- …and retirement of our colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no cost or for a low ... as well as free telemedicine services and free AirMed medical transportation. + Additional options for dental and vision...disposal of all expired medications + Monitors trends in utilization of reverse distributors to minimize wastage + Assists… more
- Pfizer (Tallahassee, FL)
- …and applying insights in local planning + Act decisively by prioritizing resource utilization to meet customer needs + Provide key HQ colleagues, including Brand ... actionable, and solutions focused feedback + Ensure effective and compliant utilization of promotional materials. + Ensure successful, compliant selling activities… more