- Molina Healthcare (St. Petersburg, FL)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). **MULTI STATE / COMPACT LICENSURE**… more
- HCA Healthcare (Ocala, FL)
- …of the Pharmacy department. + Maintain an active role in the Medication Utilization Evaluation and Adverse Drug Reaction reporting. + Supports staff in the Pharmacy ... to promote rational drug therapy and make improvements identified by drug utilization evaluations + Provide accurate and timely medication information to healthcare… more
- Evolent (Tallahassee, FL)
- …focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and procedures ... **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company policies and procedures.… more
- Evolent (Tallahassee, FL)
- …As a Clinical Reviewer, Physical Therapy you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in ... reviewers are supported by Physician clinical review staff (MDs) in the utilization management determination process. **What You Will Be Doing:** + Reviews charts… more
- Highmark Health (Tallahassee, FL)
- …including gathering data from multiple sources related to Benefit/Claim Utilization , Enrollment, Networks ( utilization , disruption, geo-access) and making ... of their data analysis.This includes benefits design analysis based on benefit utilization while factoring in financial analysis to determine cost impact. +… more
- Centene Corporation (Tallahassee, FL)
- …taken on member medical records in health management systems according to utilization management policies and guidelines + Works with healthcare providers to approve ... and concurrent review findings + Assists with providing education to providers on utilization processes to ensure high quality appropriate care to members + Provides… more
- Humana (Tallahassee, FL)
- …with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or post ... insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review organization, such… more
- AdventHealth (Winter Garden, FL)
- …to nurses, physicians and the interdisciplinary team on issues related to utilization of resources, medical necessity, CMS CoP for Discharge Planning and care ... documents avoidable days, and facilitates progression of care. Collaborates with Utilization Management staff for collaboration on patient status changes and medical… more
- TECO Energy (Ybor City, FL)
- …asset auto discovery tool to maintain compliance. Review contract and license utilization to ensure compliance is maintained for software installation. (20%) 4. ... reporting and software licensing compliance reporting. Review contract and license utilization to ensure compliance is maintained for software installation. Lead in… more
- AdventHealth (Orlando, FL)
- …pharmacy services and medication therapy. Supports medication procurement and utilization and facilitates evidence-based medication use and purchasing of ... are available to medical and nursing staff to improve medication utilization and enhance treatment outcomes. Provides education to staff, enforces departmental… more