- Molina Healthcare (Miami, FL)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... needed. + Processes requests within required timelines. + Refers appropriate cases to Medical Directors and presents them in a consistent and efficient manner. +… more
- Molina Healthcare (St. Petersburg, FL)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests additional information from members or providers in… more
- AdventHealth (Altamonte Springs, FL)
- …Utilization Management, the Physician Advisor is responsible for providing clinical review of utilization , claims management, and quality assurance related to ... Care Management teams + Provides education and serves as a resource to Medical Staff colleagues regarding best practices, Utilization Management and Care… more
- BAYADA Home Health Care (Orlando, FL)
- …+ Candidates should be available Monday-Friday from 8:30am-5:00pm. _Medicare, Coder, OASIS Review , Utilization Review , Quality Assurance, Remote, Home Health ... Home Health Care is hiring a full time OASIS Review and Coding Manager. The OASIS and Coding ...Paid holidays, vacation and sick leave, vision, dental and medical health plans, employer paid life insurance, 401k with… more
- BAYADA Home Health Care (Orlando, FL)
- …your career with an industry leader. Apply now for immediate consideration. OASIS Review , Utilization Review , Quality Assurance, Remote, Home Health Coding, ... immediate opening for a **Full Time,** OASIS and Coding Review Manager with OASIS and Coding certification to work...Paid holidays, vacation and sick leave, vision, dental and medical health plans, employer paid life insurance, 401k with… more
- Molina Healthcare (Miami, FL)
- …Experience Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests additional information from members or providers in… more
- AdventHealth (Tampa, FL)
- …Utilization Management, the Physician Advisor is responsible for providing clinical review of utilization , claims management, and quality assurance related to ... and Care Management teams Provides education and serves as a resource to Medical Staff colleagues regarding best practices, Utilization Management and Care… more
- Molina Healthcare (St. Petersburg, FL)
- …practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment, disease ... productivity standards. Educates and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy … more
- Evolent (Tallahassee, FL)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical ...within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure… more
- Elevance Health (Miami, FL)
- …members. The medical director provides clinical expertise in all aspects of utilization review and case management. Provides input on the clinical relevance ... services by members. Involved in identifying and managing medical utilization trends, emerging trends and market...state or territory of the United States when conducting utilization review or an appeals consideration and… more