- HCA Healthcare (Gainesville, FL)
- …with physicians, patients, families, hospital staff, and outside agencies + Performs utilization management reviews and communicates information to third party ... is preferred + BSN is preferred + Certification in Case Management , Nursing or Utilization Review is preferred HCA Florida North Florida Hospital is a 523-bed,… more
- Evolent (Tallahassee, FL)
- …billing and various sites of care/service + Familiarity with value-based care and utilization management + Understanding of data systems and the critical ... member-centric products. This role plays a critical part in both **Medical Cost Management ** and **Product Management ** , leveraging advanced analytics to solve… more
- Centers Plan for Healthy Living (Margate, FL)
- …accepting applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works within a multidisciplinary team ... or support in their home to improve their quality of life. Utilization Management Clinical Reviewer will assess and process all authorization requests to… more
- HCA Healthcare (Fort Walton Beach, FL)
- …with physicians, patients, families, hospital staff, and outside agencies + Performs utilization management reviews and communicates information to third party ... is preferred + BSN is preferred + Certification in Case Management , Nursing or Utilization Review is preferred HCA Florida Fort Walton-Destin Hospital is a… more
- Evolent (Tallahassee, FL)
- …critical role in **Performance Suite risk arrangements with payers and strategic utilization management initiatives.** This is an opportunity for a ... developing cardiovascular programs that include improvements to clinical effectiveness of utilization management (UM) and risk-based models.** + Process… more
- Intermountain Health (Tallahassee, FL)
- …cost-effective outcomes. Provides focused support to various areas such as utilization management , emergency department, acute, ambulatory and specialty care. ... in examining patterns of health care needs, decisions, lifestyle choices, and utilization of resources that affect their health. + Advocates, educates and coaches… more
- Molina Healthcare (St. Petersburg, FL)
- …of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. ... ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review. + Minimum two years of experience in… more
- Evolent (Tallahassee, FL)
- …design and implement intuitive, efficient, and engaging user interfaces for our Utilization Management health care workflow applications. User research and ... with health care software development methodologies and lifecycles + Experience with utilization management and/or prior authorization processes is preferred +… more
- Elevance Health (Miami, FL)
- …role required by a State agency. **Preferred Skills, Capabilities, and Experiences:** + Utilization Management experience is a plus. + Ability to meet necessary ... clinical reviews. + The Medical Director typically has program management responsibilities including clinical policy development, programdevelopment/implementation,and overseeingclinical/non-clinicalactivities. **Minimum… more
- Molina Healthcare (Tampa, FL)
- …Experience Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... / MCG guidelines. To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal… more