- CVS Health (Tallahassee, FL)
- …Medical Director referral as needed. + Assists management with training new nurse reviewers/business partners or vendors to include initial and ongoing mentoring, ... client needs. + Recommends, tests, and implements process improvements, new audit concepts, technology improvements, etc. that enhance production, quality, and… more
- Molina Healthcare (Tampa, FL)
- …outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases ... Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + Identifies and… more
- MyFlorida (Largo, FL)
- …Paid holidays and personal day. Retirement package. REQUIREMENTS + Unencumbered Florida Registered Nurse License. + Must be willing and able to travel throughout all ... or more years of experience as a Licensed Registered Nurse in Long-Term Care facility. + Experience as a...in the State Veterans' Homes by researching and the utilization of evidenced based clinical practices. Oversees the clinical… more
- YesCare Corp (Tallahassee, FL)
- …County in Tallahassee, FL** **Administrative** + Serve as Chairman of the Medical Audit Committee. + Consult with medical providers in the community to resolve ... of care and chart reviews as requested. Sponsors physician assistants or nurse practitioners as required. + Notifies Regional Medical Director and Site Health… more
- MTC (Quincy, FL)
- …the duties of the position. 11. Practice advanced cost containment and utilization management for inmate care and facility operations. 12. Maintain absolute security ... provided services are documented. 14. Closely monitor illnesses. 15. Audit pharmacy use for adherence to formulary and compliance...(1) year supervisory experience. Must be a licensed registered nurse in the state of Florida or compact state.… more
- MTC (Quincy, FL)
- …history of assigned patients. 3. Prepare patients for examinations and assist nurse or provider during examination. 4. Work efficiently to ensure providers have ... maintain inventory PAR levels. 15. Practice basic cost containment and utilization management techniques. 16. Attend scheduled staff meetings; promote communication… more
- CenterWell (Daytona Beach, FL)
- …+ Overseeing other clinicians which includes Physicians, Advanced Registered Nurse Practitioners (ARNP), and Physicians Assistants (PA) + Maintaining Collaborative ... and complaints from patients + Ongoing chart review / audit of clinical staff to ensure quality care and...+ Identifying trends and areas of opportunity in pharmacy utilization (pharmacy management) to impact Part D per Member… more