- Humana (Tallahassee, FL)
- …with medical terminology and/or ICD-10 codes. + Member service + Experience with Utilization Review and/or Prior Authorization, preferably within a managed care ... of our caring community and help us put health first** The Bilingual Telephonic UM Coordinator / UM Administration Coordinator 2 provides non-clinical support for… more
- Humana (Hallandale Beach, FL)
- …ensure interaction between the company and members are optimized. The Telephonic Behavioral Health Care Manager Internship provides transitioning service members ... requirements to achieve and/or maintain optimal wellness state in a remote telephonic environment. The Behavioral Health Care Manager guides members and/or families… more
- Elevance Health (Miami, FL)
- ** Telephonic Nurse Case Manager II** **Location: This role enables associates to work virtually full-time, with the exception of required in-person training ... members in different states; therefore, Multi-State Licensure will be required.** The ** Telephonic Nurse Case Manager II** is responsible for care management within… more
- ChenMed (Pembroke Pines, FL)
- …engagement with patient and family. + Facilitate patient/family conferences to review treatment goals, optimize resource utilization , provide family education ... achieving desired clinical outcomes within specific timeframe. + Conducts review for appropriate utilization of services from...Responsibilities Include but are not limited to: + Provide telephonic or outpatient visits to patients at high risk… more
- ChenMed (Opa Locka, FL)
- …engagement with patient and family. + Facilitates patient/family conferences to review treatment goals and optimize resource utilization ; provides family ... assist in achieving desired clinical outcomes within specific timeframe. + Conducts review for appropriate utilization of services from admission through… more
- Highmark Health (Tallahassee, FL)
- …NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the ... job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the...of service. Depending on the nature of the case, telephonic peer to peer discussions may be required. The… more
- Sharecare (Tallahassee, FL)
- …and objectives of the Disease Management program by providing high quality telephonic and omni - channel support in an appropriate, efficient and cost-effective ... nurse helps to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse...and to take the pre and post tests to review competency during orientation. Yearly competency tests are required… more
- CVS Health (Tallahassee, FL)
- …with transferring patients to lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC recognized accreditation preferred. + ... AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support… more
- CVS Health (Lakeland, FL)
- …your understanding of patient safety and error prevention, quality assurance drug utilization review (DUR), pharmacy professional standards such as corresponding ... appropriate under the direct supervision of a licensed pharmacist + Taking telephonic prescriptions from the prescriber, and calling the prescriber to clarify… more
- CVS Health (Tallahassee, FL)
- …to their next care setting. **Position Responsibilities:** . Responsible for telephonic and/or face to face assessing, planning, implementing, and coordinating all ... overall wellness through integration. . Using clinical tools and information/data review , conducts comprehensive assessments of member's needs and recommends an… more