- Humana (Tallahassee, FL)
- …Qualifications** + Bachelor's degree. + Previous experience in utilization management . + Previous Medicare/Medicaid experience. + Previous case management ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...needs. + **Work Location:** must reside in Florida. + ** Travel :** no more than 5% based on business needs.… more
- Florida Health Care Plans, Inc. (Daytona Beach, FL)
- … within the community to various locations. POSITION SUMMARY: As part of the Utilization Management division, the social worker will intervene with members who ... order to fully engage with members and their families, travel to hospitals, rehab or skilled nursing facilities and...relationships with FHCP colleagues and external vendors in providing case management services is essential to the… more
- HCA Healthcare (Fort Lauderdale, FL)
- …+ Lead centralized case management function, including Clinical Case Management , Utilization Review Services, and Clinical Documentation Improvement. ... HCA established policies, practices, efficiencies; and effectiveness of clinical Case Management , Utilization Management...preferred + The job may require up to 50% travel Knowledge, Skills Abilities & Behaviors: + Lead centralized… more
- ChenMed (North Miami Beach, FL)
- …of 2 years' clinical work experience required. + A minimum of 1 year of utilization review and/or case management , home health, hospital discharge planning ... + Directs referrals to preferred providers. + Coordinates the integration of social services/ case management functions in the pre-acute, ER, acute and post-acute… more
- CVS Health (Orlando, FL)
- …issues. . Handles reviews of prior claims to address potential impact on current case management and eligibility. . Creates a holistic approach to assess the ... to clinical resources and to assist in determining functionality. . Ensures case management processes follow organization and regulatory requirements. .… more
- CVS Health (Tallahassee, FL)
- …health professionals to influence appropriate member care. . Attends and participates in case rounds, including utilization management rounds for behavioral ... reside in South Florida . Willing and able to travel up to 20% of their time to meet...reimbursement policy **Preferred Qualifications:** . Behavioral Health Experience . Case management in an integrated model .… more
- Elevance Health (Lakeland, FL)
- …Capabilities and Experiences:** + Bilingual in Spanish strongly preferred. + Previous case management or oncology experience strongly preferred. + Experience ... This is a field based position, candidate would need travel in and around the following counties based on...of an RN, with overall responsibility for the member's case , as required by applicable state law and contract,… more
- CenterWell (Tampa, FL)
- …a part of our caring community and help us put health first** The Manager Care/ Case Management in **Tampa area (** **_this is not a remote position_** **)** ... and coordinating care to reduce acute and post-acute care utilization . The Manager role is hybrid with travel...Work degree/license + 5 years or more prior nursing, case management , disease management and/or… more
- Humana (Tallahassee, FL)
- …and interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , ... Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a… more
- Humana (Tallahassee, FL)
- …and interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , ... Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a… more