- Monogram Health (Fort Myers, FL)
- …populations Experience with NCQA, HEDIS, Medicaid, Medicare, quality improvement, medical utilization management , and risk adjustment Current state medical ... and the seamless transitions to dialysis, pre-emptive kidney transplant, conservative management . The Regional Medical Executive is a key clinical leader within… more
- University of Florida OB-GYN Department (Gainesville, FL)
- …decision support tools. This may include development, refinement and integration of utilization and disease management programs that outline services and levels ... Operations Department OBGYN Job Description: Providing direct leadership and management to clinical faculty including setting productivity and quality goals,… more
- HCA Healthcare - Chief Medical Officer (Bradenton, FL)
- …ongoing in-service programs to facility medical staff regarding clinical resource management , appropriate documents standards, utilization and quality issues, ... The CMO provides senior-level leadership to the infection control, risk management , safety, and medical staff credentialing functions, ensuring the collaboration and… more
- Jupiter Medical Center (Jupiter, FL)
- …coordinating with other departments, managing patient flow and resource utilization , and participating in quality improvement initiatives. Additionally, the Medical ... in hospitalist medicine and healthcare administration Strong leadership, team management , and organizational skills Proficiency in developing and implementing… more
- 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
- 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
