- 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
- Sanofi Group (Fort Lauderdale, FL)
- …on the local and national payer landscape, including Specialty Pharmacy and Utilization Management criteria for Dupixent + Establish positive and productive ... working relationships with all key customer segments (internal and external) + Partner with Alliance colleagues to create a culture of respect and customer focus + Develop working relationships with state societies, associations and advocacy groups, as needed,… more
- Veterans Affairs, Veterans Health Administration (Orlando, FL)
- …coordination for all patients in the dialysis unit- outpatient clinics- Inpatients with utilization management team and case managers and effectively work with ... social worker to address timely psychosocial issues Will be actively involved in teaching residents and students. Work Schedule: Monday-Friday, 8:00 am - 4:30 pm (Note: Work schedules are determined and approved by the supervisor. The incumbent may be required… more
- Centers Plan for Healthy Living (Margate, FL)
- …with the guidance and plans they need for healthy living. JOB SUMMARY: The Utilization Management Care Coordinator works within a multidisciplinary care team to ... assist with the care of members enrolled in our Managed Long Term Care program and facilitate authorization requests for eligible members. PRIMARY RESPONSIBILITIES: + Assists in the prior authorization of services and ongoing authorization requests + Assists… more
- Elevance Health (Tampa, FL)
- …with providers, claims or service issues. + Assists with development of utilization /care management policies and procedures. **Minimum Requirements:** + Requires ... **Telephonic Nurse Case Manager II** is responsible for care management within the scope of licensure for members with...assessments to identify individual needs and a specific care management plan to address objectives and goals as identified… more
- Elevance Health (Tampa, FL)
- …with providers, claims or service issues. Assists with development of utilization /care management policies and procedures. **Minimum Requirements:** + Requires ... The **Nurse Case Manager II** is responsible for care management within the scope of licensure for members with...assessments to identify individual needs and a specific care management plan to address objectives and goals as identified… more
- HCA Healthcare (Ocala, FL)
- …patient throughput while supporting a balance of optimal care and appropriate resource utilization . + Provides case management services for both inpatient and ... required + 4 year Bachelor Degree preferred. + Certification in Case Management or Utilization Review preferred HCA Florida Ocala Hospital is a 323-bed facility.… more