- Humana (Tallahassee, FL)
- …a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and… more
- Molina Healthcare (Jacksonville, FL)
- Molina Healthcare is hiring for a remote Pharmacist in our Utilization Management department. This role is 100% remote. The Pharmacist, UM will provide support ... and quality initiatives under the direction of leadership. + Monitors drug utilization and assist leadership team in understanding quality and cost-control issues… more
- Elevance Health (Miami, FL)
- ** Utilization Management Representative II** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person ... employment, unless an accommodation is granted as required by law._ The ** Utilization Management Representative II** is responsible for managing incoming calls,… more
- Cognizant (Tallahassee, FL)
- …+ Educational background - Registered Nurse (RN) + 2-3 years combined clinical and/or utilization management experience with managed health care plan + 3 years' ... in health care revenue cycle or clinic operations + Experience in utilization management to include Clinical Appeals and Grievances, precertification, initial… more
- Elevance Health (Jacksonville, FL)
- **Title: Utilization Management Representative I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required ... unless an accommodation is granted as required by law._ The ** Utilization Management Representative I** will be responsible for coordinating cases for… more
- Highmark Health (Tallahassee, FL)
- …coverage determination for prior authorization review and appeals. Through the Utilization Review system, the incumbent evaluates clinical information provided by ... requests for prior authorization or appeals against medical policy through the Utilization Review system. Update the system records appropriately to ensure claims… more
- Evolent (Tallahassee, FL)
- …Clinical Reviewer, Interventional Pain Management , you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... Director for selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical… more
- Select Medical (Lake Worth, FL)
- …focus on resource management . + Demonstrating compliance with facility-wide Utilization Management policies and procedures. + Coordinating UR compliance with ... growth of the department, including, but not limited to: Utilization Review (UR) and resource management , discharge...limited to: Utilization Review (UR) and resource management , discharge planning, treatment plan management and… more
- Humana (Tallahassee, FL)
- …interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , discharge ... Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a… more
- Select Medical (Gainesville, FL)
- …focus on resource management . + Demonstrating compliance with facility-wide Utilization Management policies and procedures. + Coordinating UR compliance with ... growth of the department, including, but not limited to: Utilization Review (UR) and resource management , discharge...limited to: Utilization Review (UR) and resource management , discharge planning, treatment plan management and… more