- Actalent (Sunrise, FL)
- Utilization Management Nurse !Job Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing service authorization requests to ... the development of programs, policies, and procedures for continuous quality improvement. + Assure adherence to company and department...Interqual + Milliman Commercial Guidelines + Medicaid + Medical management + Medicare + Managed care +… more
- AdventHealth (Altamonte Springs, FL)
- …and executive sponsor with responsibility for developing and executing a comprehensive quality management program that drives high-value care to achieve clinical ... President of Quality will be responsible for leading a comprehensive quality management program encompassing both the Central Florida South Division (CFD-S)… more
- AdventHealth (Altamonte Springs, FL)
- …team regarding documentation guidelines, including attending physicians, allied health practitioners, nursing , care management and quality abstracters. The ... including attending physicians, allied health practitioners, nursing , and care management . This includes quarterly compliance updates from Medicare . +… more
- Humana (Tallahassee, FL)
- …and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to support the coordination, documentation ... of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied...need it. These efforts are leading to a better quality of life for people with Medicare ,… more
- Banner Health (FL)
- …improvement and quality management . Assists and participates with management through committees to properly educate physicians, nursing , coders, CDM's, ... clinical documentation and billing codes. Works with clinical documentation improvement and quality management staff to: align diagnosis coding to documentation… more
- AdventHealth (Orlando, FL)
- …and acquires necessary resources/services to improve patients' chances of successful self- management . Seeks opportunities for improvement in quality of ... Debt-free Education (Certifications and Degrees without out-of-pocket tuition expense) + Nursing Clinical Ladder Program **Our promise to you:** Joining AdventHealth… more
- Humana (Tallahassee, FL)
- …they need, when they need it. These efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service ... help us put health first** The Care Manager, Telephonic Nurse 2 employs a variety of strategies, approaches and...Our nurses are titled Care Managers, because our case management services are centered on the person rather than… more
- Elevance Health (Tampa, FL)
- …workload involving complex areas of Medicare part A reimbursement such as Medicare DSH, Bad Debts, Medical Education, Nursing and Allied Health, Organ ... Health's family of brands. We administer government contracts for Medicare and partner with the Centers for Medicare...perform all duties of lower-level positions as directed by management . + Participate in development and maintenance of Audit… more
- Molina Healthcare (Miami, FL)
- … Improvement (QI) leader within the organization, empowered to advise senior management and other departments on Quality strategies and initiatives. This ... programs. + 2 years Medicaid experience + 2 years Medicare experience + 3 years management experience...**Preferred License, Certification, Association** + Certified Professional in Health Quality (CPHQ) + Nursing License (RN may… more
- Aveanna Healthcare (Tampa, FL)
- …staff to provide safe and high- quality care. + Oversee internal case management , nursing talent evaluation, and professional development. + Conduct "Start of ... business development teams. + Maintain and improve a comprehensive quality assurance program for nursing services. +...of practice. + Minimum of 1 year of hands-on nursing experience (1 year of management experience… more