- Molina Healthcare (FL)
- …United States who has a compact, multi-state license. This team reviews the prior authorization requests for transplants; the ideal candidate will have ... experience either in utilization review or case management for transplants....and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility… more
- Centers Plan for Healthy Living (Margate, FL)
- …with the guidance and plans they need for healthy living. JOB SUMMARY: The Utilization Management Care Coordinator works within a multidisciplinary care team to ... requests for eligible members. PRIMARY RESPONSIBILITIES: + Assists in the prior authorization of services and ongoing authorization requests + Assists in… more
- Evolent (Tallahassee, FL)
- …working seamlessly with diverse teams and stakeholders. + Deep understanding of prior authorization processes, reporting, and key performance indicators (eg, ... leadership is preferred. + Familiarity with value-based care models and utilization management frameworks is preferred. **Technical Requirements:** We require… more
- Copeland (Palm Beach Gardens, FL)
- …ensuring they meet employee needs and regulatory requirements.** **Vendor Relationship Management :** **Oversee and manage relationships with plan vendors, such as ... investment advisors and administrators, including sourcing, selection, and ongoing management of vendor partnerships.** **Retirement Investment Committee Support:** **Serve… more
- University of Miami (Medley, FL)
- …parties of the appointment time, referral criteria, insurance verification, and prior authorization requirements. . + Contact insurance company through ... and Patient Access teams to assure pre-registration in the appropriate facility prior to the appointment. + Provide verification of enrollment and deductible status… more
- Molina Healthcare (Tampa, FL)
- …**Preferred Experience** Previous experience in ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed. + Processes… more
- Mayo Clinic (Jacksonville, FL)
- …patient plan of care throughout the continuum of care by ensuring appropriate utilization management , care coordination, resource utilization , and clinical ... RN Case Manager provides leadership through education on case management / utilization management concepts, committee work,...associate degree registered nurses with a RN start date prior to April 1, 2020 must provide documented evidence… more
- MyFlorida (St. Petersburg, FL)
- …Directions Behavioral Health program, review clinical notes match claims and authorization . Knowledge, skills and abilities, including utilization of equipment, ... Specialty Care. Develops procedures to evaluate medical necessity. + Evaluates authorization requests for specialty care referrals in accordance to the established… more
- Cardinal Health (Tallahassee, FL)
- …intake, investigating all patient health insurance benefits, identifying & initiating prior authorization and step therapy reviews, proactively following up ... guidance on the appeals process if needed. + Assist in obtaining insurance, prior authorization , and appeal requirements and outcomes. + Demonstrate expertise in… more
- Molina Healthcare (Jacksonville, FL)
- …Services, pharmacies, and health plan providers in resolving member prescription claim, prior authorization , or pharmacy services access issues. * Articulates ... and state laws. Jobs in this family include those involved in formulary management (such as, reviewing drug/provider utilization patterns and pharmacy costs … more
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