- Highmark Health (Tallahassee, FL)
- …Provide analytical/strategic-thinking and leadership support that enables the medical policy and utilization management teams to: 1) isolate business issues; 2) ... to junior team members; Provide performance input and recommendations to management for development/ training plans. May have supervisory responsibilities on a… more
- Humana (Miramar, FL)
- …referral source and provider interactions and communications. Work with Pre-Authorization, Utilization Management , Billing, Pharmacy, Home Care and DME regarding ... The Pre-Service Coordinator is responsible for all aspects of referral management and accurately process incoming requests for homecare, DME/supplies and… more
- Humana (Tallahassee, FL)
- …to deliver exceptional, person-centered support to members through role-specific care and utilization management activities. This is an opportunity to foster ... and optimize learning processes, including program marketing, registration, resource management , and follow-up communications. + Plan for departmental growth and… more
- Molina Healthcare (Orlando, FL)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... software program(s) proficiency. Preferred Qualifications * Certified Professional in Healthcare Management (CPHM). * Recent hospital experience in an intensive care… more
- Community Health Systems (Naples, FL)
- Join us as a **Registered Nurse (RN) - Utilization Review position** at Physicians Regional Collier Unit: Utilization Review Shift: Mon-Fri (this is an onsite ... match & more available for Full and Part-Time roles **Job Summary** The Utilization Review Nurse - RN reviews hospital admissions, extended stays, and supporting… more
- Elevance Health (Tampa, FL)
- …solving with providers, claims or service issues. + Assists with development of utilization /care management policies and procedures. + Within the medical ... II** will be responsible for providing case and/or medical management for members receiving transplant services. Continue to learn...for advancement to the senior level. Within the case management role will within the scope of licensure assess,… more
- HCA Healthcare (Gainesville, FL)
- …and improve the patient flow program effectiveness as it relates to utilization review, resource management , and discharge planning and care coordination. ... hospitalists & PCP's to address and resolve issues related to facility utilization and patient flow process and facilitate strong working relationship between… more
- Highmark Health (Tallahassee, FL)
- …expertise.This may include updating/revising existing medical policies. + Partner with Utilization Management and other operational teams to identify ... opportunities within medical policy. + Discover and cultivate innovative opportunities that drive significant improvements in healthcare quality and efficiency. + Other duties as assigned or requested. **EXPERIENCE** **Required** + 5 years of Active medical… more
- Evolent (Tallahassee, FL)
- …medical review roles that emphasize volume throughput, this position integrates utilization management with collaborative engagement and innovation. **Core ... Responsibilities** + **Clinical Review & Peer Collaboration** + Serve as the physician reviewer for oncology cases that do not initially meet medical necessity criteria, applying evidence-based guidelines to ensure high-quality and cost-effective care. +… more
- Mindoula Health (FL)
- …for outcome based care. + Participates in interdisciplinary team meetings and utilization management rounds and provides information to assist with safe ... transitions of care. + Promotes responsible and ethical stewardship of company resources. + Maintains excellent punctuality and attendance during work hours. Qualifications: + LCSW, LMFT, LPC, LMHC in Florida. + Preferred experience with substance abuse… more
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