- Trinity Health (Fort Lauderdale, FL)
- …Plans to ensure authorization for hospital stay. Hybrid Position **_Position Purpose:_** ** Utilization Review (UR) Nurses play a vital role in healthcare by making ... clinical experience is required.** Recent experience in case management, utilization review, discharge planning, ongoing monitoring and evaluation of patient… more
- CVS Health (Tallahassee, FL)
- …day. **Position Summary** **Fully remote with requirement to reside in Florida.** + Utilization Management is a 24/7 operation and the work schedule may include ... Florida + Must reside in Florida + 3+ years of clinical experience + Utilization Management is a 24/7 operation and work schedule may include weekends, holidays, and… 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 have ... complex health and psychosocial needs and high-risk populations to ensure optimal clinical outcomes. Services may include consultation, discharge planning, education, crisis intervention, counseling, advocacy and information on referral services to assist… more
- Community Health Systems (Naples, FL)
- …Under the direction of the UR Director/Manager the UR Nurse reviews all admissions for medical necessity, correct orders based on medical condition (inpt vs OBS). ... Facilitates concurrent reviews and authorizations for admissions. This position will support the development of policies and procedures, standard work and educational materials for the UR department. Will be a partner with other staff members, providers, and… more
- Actalent (Sunrise, FL)
- Utilization Management Nurse!Job Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing service authorization requests to ensure ... appropriate service utilization . Working under the general supervision of the Director...Medical Directors and other Medical Management staff to direct utilization and capture data effectively. Responsibilities + Review prior… more
- AdventHealth (Altamonte Springs, FL)
- …role you will contribute:** The Physician Advisor provides primary support for Utilization Management (UM) and secondary support for Care Management (CM) departments ... Advisor is responsible for educating, informing and advising members of the Utilization Management, Care Management, Managed Care and Revenue Cycle departments and… more
- Molina Healthcare (FL)
- …Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/ utilization review, and/or other utilization management activities ... clinical and non-clinical team activities to facilitate integrated, proactive utilization management, ensuring compliance with regulatory and accrediting standards.… more
- Molina Healthcare (FL)
- …and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource ... management. + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure a high quality of patient care,… more
- AdventHealth (Orlando, FL)
- …you'll contribute:** The Population Health Case Manager (PHCM) ensures effective utilization and case management oversight activities as defined by inter ... best practices, agency policies/processes. Ensures clear and appropriate visit utilization using evidence-based and best practice guidelines to achieve positive… more
- Centene Corporation (Tallahassee, FL)
- …be a Florida resident. + Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities. + Performs ... medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services,… more