- CVS Health (Tallahassee, FL)
- …of clinical experience in acute or post-acute setting, and 1+ years of Utilization Management / Care Management Experience + Must have active current and ... additional Nursing Licenses as business needs require. **Preferred Qualifications** Utilization Management experience preferred **Education** Education: Diploma RN acceptable;… more
- CenterWell (Tallahassee, FL)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare +… more
- YesCare Corp (Bartow, FL)
- Join YesCare as a Utilization Manager **Licensed Practical Nurse (LPN)** and play a critical role in delivering compassionate and effective patient care within our ... dynamic healthcare program. **Key Responsibilities:** + **Patient Assessment and Care Planning:** + Assist in assessing the health status of patients and contribute to the development and modification of individualized care plans. + **Direct Patient Care:** +… more
- Wolters Kluwer (Tampa, FL)
- …Engagement Manager plays a high-impact role in managing strategy and product utilization across the Wolters Kluwer Health's Clinical Decision Support & Provider ... are established and strengthened, drive product adoption and ensure utilization goals are achieved to maximize value realization, implementation projects… more
- Highmark Health (Tallahassee, FL)
- …This role supports the full application product lifecycle for **clinical and utilization management software** , with a specific focus on driving key technical ... They function as a pivotal bridge, translating high-level **clinical and utilization management software** business needs into detailed technical requirements for… more
- Molina Healthcare (FL)
- …of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies to ensure ... most appropriate care at the most effective setting. *Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and under-… more
- Centene Corporation (Tallahassee, FL)
- …in Florida + Board certified in Pediatrics or Family Medicine + Utilization Management experience and knowledge of quality accreditation standards. + Actively ... for the business unit. + Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities. + Performs… more
- ChenMed (Lauderhill, FL)
- …leaders, external clients and HMO to establish, maintain and support outpatient utilization management in PMR and delegated utilization management in ChenMed ... **_Other responsibilities may include:_** + Drive the current delegated/non-delegated utilization management model to a sustainable and reproducible one dependent… more
- Evolent (Tallahassee, FL)
- …the mission. Stay for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to make a ... meaningful impact on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director, Cardiovascular Specialist and use your… more
- RxBenefits (Jacksonville, FL)
- …channel management, B/G classifications, specialty designations, rebate eligibility, utilization trend, Utilization Management (UM) implications, Manufacturer ... structure, new prospect member size, marketing agreements, broker commissions, and drug utilization . + Be the SME on dozens of medical vendor/PBM contracts including… more