- Molina Healthcare (FL)
- …needed. + Processes requests within required timelines. + Refers appropriate cases to Medical Directors and presents them in a consistent and efficient manner. + ... School of Nursing. **Required Experience** 3+ years hospital acute care/ medical experience. **Required License, Certification, Association** Active, unrestricted State… more
- HCA Healthcare (Port St. Lucie, FL)
- …a data-driven environment of quality and cost improvement and develops systems to review utilization of resources and objectively measure outcomes of care in ... for appeals and denials process, discharge planning, case management, and utilization review /management. + Consults with facility-level staff regarding delegated… 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 ... when available, within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the… 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 ... + Provides clinical rationale for standard and expedited appeals. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …environment. + Minimum 2 years of experience with pre-authorization, utilization review /management, case management, care coordination, and/or discharge ... or MCG(R) screening criteria. Responsibilities: + Manages appropriate cases that require medical necessity review such as home care, elective inpatient and… more
- AdventHealth (Altamonte Springs, FL)
- …resource utilization , ultimately resulting in enhanced patient service, improved medical staff satisfaction, and reduced costs. Furthermore, the CMO bears the ... **GENERAL SUMMARY:** Reporting directly to the hospital CEO, the Chief Medical Officer (CMO) assumes a pivotal role in providing physician leadership and enhancing… 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 ... and provides clinical rationale for standard and expedited appeals. . Utilizes medical /clinical review guidelines and parameters to assure consistency in the… 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 ... and provides clinical rationale for standard and expedited appeals. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the… 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 ... Management, you will be a key member of the utilization management team. We can offer you a meaningful...within the regulatory timeframe of the request. + Utilizes medical /clinical review guidelines and parameters to assure… 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 ... and provides clinical rationale for standard and expedited appeals. + Utilizes medical /clinical review guidelines and parameters to assure consistency in the… more