- 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
- 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
- ICW Group (Orlando, FL)
- …with ongoing monitoring to ensure quality and appropriate service delivery of the case management process. + Performs initial and ongoing clinical assessment via ... ensures support systems are in place. + Creates a case management plan based on the assessment...+ Interfaces with external agencies in relation to the utilization review process including, Third-Party Payers, Insurance Companies and… 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
- 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
- ChenMed (Winter Park, FL)
- …Compact license required if available in state. + A minimum of 2 years' onsite case management at ChenMed and/or utilization review or discharge planning in ... team, family, and providers. + Assists with development and implementation of case management policies, processes, and standard operating procedures (SOPs) as… 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
- 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