- Sharecare (Tallahassee, FL)
- …hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management ( UM ) status, including but not limited to medical, dental, and vision ... for care management and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case management assistance +… more
- Molina Healthcare (FL)
- …Collaborates with multidisciplinary teams to promote Molina Care Model + Adheres to UM policies and procedures. + Occasional travel to other Molina offices or ... meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN). **Required Experience** 1-3 years of hospital or medical… more
- Molina Healthcare (St. Petersburg, FL)
- …appropriate care at the most effective setting. Evaluates the effectiveness of UM practices. Actively monitors for over and under-utilization. Assumes a leadership ... Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review, and manages the denial… more
- NCH (Naples, FL)
- …at regular scheduled CDI team meetings as well as other meetings (ie UM /Quality etc). * Collaborative interaction with physicians and/or other clinicians to enhance ... Minimum of Associate Degree required; Bachelor's Degree preferred. * Licensed as a Registered Nurse in the state of Florida. * 5+ years CDI auditing/SLR or education… more
- University of Miami (Miami, FL)
- …lodging for patients transferring to or seeking services at UM facilities including ambulance/air-ambulance services. + Schedules appointments, registers patients, ... care team, and department leadership. + Refer to financial counselors, social work, or nurse navigation when indicated and to reduce barriers to care. + Refer to… more