- 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
- Humana (Tallahassee, FL)
- …conducting comprehensive reviews of medication care plans. This includes evaluating medical necessity, analyzing overall utilization , and identifying unusual ... Qualifications:** + Experience in managed care pharmacy, particularly in utilization management review **Additional Information:** **Interview Format**… more
- Humana (Tallahassee, FL)
- …new systems (proficient to advanced) **Preferred Qualifications** + Experience with Utilization Review and/or Prior Authorization, preferably within a managed ... first** The UM Administration Coordinator contributes to administration of utilization management. The UM Administration Coordinator 2 performs varied activities… 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
- Molina Healthcare (Miami, FL)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... requests within required timelines. + Refers appropriate cases to Medical Directors and presents them in a consistent and...+ Adheres to UM policies and procedures. + Occasional travel to other Molina offices or hospitals as requested,… 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
- 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 ... - Friday 8:00 AM to 5:00 PM EST Remote position with 25% field travel MA RN license **KNOWLEDGE/SKILLS/ABILITIES** + Assists in training of all staff according to… 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
- Molina Healthcare (Miami, FL)
- …needed. + Processes requests within required timelines. + Refers appropriate cases to Medical Directors and presents them in a consistent and efficient manner. + ... promote Molina Care Model. + Adheres to UM policies and procedures. + Occasional travel to other Molina offices or hospitals as requested, may be required. This can… more
- Humana (Tallahassee, FL)
- …group practice management. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, ... to operationalize this knowledge in their daily work. The Medical Director's work includes computer-based review of...on size of region or line of business. The Medical Director conducts Utilization Management of the… more