- Evolent (Tallahassee, FL)
- …match reviewer for Spine Surgery cases. you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in ... to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization … more
- Veterans Affairs, Veterans Health Administration (Miami, FL)
- …goals for eligibility, referral and authorization, care coordination, and utilization management to ensure improved Veteran experience. Makes recommendations for ... improving the Veteran's experience and outcomes. Defines mental health policies, utilization management process and procedures, financial and utilization reports… more
- Evolent (Tallahassee, FL)
- …to the support services review process. Responsible for the quality of utilization review determinations, including appeals. + Provides input into audit processes ... training classes as needed for new hires to educate and train on Utilization management system and Field Medical Director process, standards and resources. + Acts… more
- HCA Healthcare (Tallahassee, FL)
- …throughput while supporting a balance of optimal care and appropriate resource utilization . The RN CM Care Coordinator will identify potential barriers to patient ... processes, for the appropriate level of care, patient status and resource utilization + Conducts interdisciplinary team meetings to provide a mechanism for all… more
- Humana (Tallahassee, FL)
- …present data for enhanced benefits and In Lieu of Service (ILOS) utilization across all Medicaid programs. This role involves identifying trends and relationships ... **Data Management and Modeling:** + Create and monitor benefit and ILOS utilization reports across all Medicaid programs. + Collect, integrate, analyze, synthesize,… more
- CVS Health (Tallahassee, FL)
- …level. The Associate Manager is also responsible for oversight of utilization management nurses including the organization and development of high performing ... team maintains compliance and privacy practices. + Oversees the implementation of utilization management services for assigned area + Implements clinical policies &… more
- Healthfirst (FL)
- The Case Manager, Utilization Management coordinates the care plan for assigned members and conducts pre-certification, concurrent review, discharge planning, and ... case management as assigned. The Case Manager, Utilization Management is also responsible for efficient ... Utilization Management is also responsible for efficient utilization of health services and optimal health outcomes for… more
- HCA Healthcare (Largo, FL)
- …PI labor and facility leaders and executives to ensure optimal utilization to support staffing requirements/expectations. This individual should possess excellent ... other Financial Resiliency initiatives to include but not limited to PRN utilization , overtime, weekend commitment, and under/over commitment. + Responsible for the… more
- Centene Corporation (New Port Richey, FL)
- …issue resolution. Drive optimal performance in contract incentive performance, quality, and cost utilization . + Serve as primary contact for providers and act as a ... in the following areas: Risk/P4Q, Health Benefit Ratio (HBR), HEDIS/quality, cost and utilization , etc. + Completes special projects as assigned + Ability to travel… more
- Evolent (Tallahassee, FL)
- …Doing:** Job Description As a FMD, Radiology you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in ... to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization … more