- Humana (Tallahassee, FL)
- …focused on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience + Working with health insurance ... organizations, hospitals and other healthcare providers, patient interaction, etc. **Work at Home Guidance** To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office… more
- Molina Healthcare (FL)
- …Medical, or ER unit. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). 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 Opportunity Employer (EOE) M/F/D/V. Pay… more
- Norstella (Tallahassee, FL)
- …or Specialty pharmacy. + Comprehensive knowledge of both pharmacy and medical benefit utilization management policies + Proven ability to exceed expectations and ... achieve goals + Excellent presentation and communication skills + Strong analytical and critical thinking skills + Strong organization skills with the ability to prioritize in a dynamic environment + Self-motivated with a strong "can do" attitude **Additional… 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
- Evolent (Tallahassee, FL)
- …care, HIPAA, provider and vendor contracting, compliance, population health (including utilization management ), Medicare, and Medicaid. + Draft, review and ... negotiate contracts with providers, vendors, managed care customers, and other third parties to ensure compliance with applicable statutes, case law, governmental regulations and Evolent policy guidelines. Analyze and advise business owners of contractual… 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
- Mindoula Health (FL)
- …ownership for outcome based care. + Participate in interdisciplinary team meetings and utilization management rounds and provides information to assist with safe ... transitions of care. + Promote responsible and ethical stewardship of company resources. + Maintain excellent punctuality and attendance during work hours. Comprehensive Benefits Package includes: + Medical, Dental and Vision Insurance + Supplemental Life… more
- BayCare Health System (Largo, FL)
- …of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Coordinator(Homecare) responsibilities include:** + Coordinates utilization ... and admission documentation completeness. + Communicates to and educates staff regarding utilization and paperwork issues. + One UR will be responsible for a… more
- Molina Healthcare (St. Petersburg, FL)
- …Experience** 3-5 years clinical practice with managed care, hospital nursing, utilization and/or care management experience. **Preferred License, Certification, ... the health plan HCS Department staff. Consults with the Management of HCS to devise and implement corrective action...courses required to obtain licensure in all states. + Utilization Review Lead responsibilities also include but not limited… 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 + 1 year experience in acute hospital with… more