- Actalent (Orlando, FL)
- …to validate the necessity and setting of care. Essential Skills + Proficiency in utilization management and utilization review + Experience with Interqual ... such as ICU, ER, Med-Surge, PACU, etc. + Strong multitasking and time management abilities. + Quick learner with a go-with-the-flow attitude. + Proficient with… more
- Trinity Health (Fort Lauderdale, FL)
- …acute hospital clinical experience is required.** Recent experience in case management , utilization review, discharge planning, ongoing monitoring and evaluation ... Plans to ensure authorization for hospital stay. Hybrid Position **_Position Purpose:_** ** Utilization Review (UR) Nurses play a vital role in healthcare by making… more
- AdventHealth (Altamonte Springs, FL)
- …FL **The role you will contribute:** The Physician Advisor provides primary support for Utilization Management (UM) and secondary support for Care Management ... is responsible for educating, informing and advising members of the Utilization Management , Care Management , Managed Care and Revenue Cycle departments… more
- Actalent (Sunrise, FL)
- Utilization Management Nurse!Job Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing service authorization requests to ... activities as assigned. Essential Skills + Clinical review + Utilization review + Utilization management + Interqual + Milliman Commercial Guidelines… more
- Select Medical (Gainesville, FL)
- …focus on resource management . + Demonstrating compliance with facility-wide Utilization Management policies and procedures. + Coordinating UR compliance with ... growth of the department, including, but not limited to: Utilization Review (UR) and resource management , discharge...limited to: Utilization Review (UR) and resource management , discharge planning, treatment plan management and… more
- HCA Healthcare (Fort Lauderdale, FL)
- …to HCA established policies, practices, efficiencies; and effectiveness of clinical Case Management , Utilization Management , and Social Work functions within ... + Lead centralized case management function, including Clinical Case Management , Utilization Review Services, and Clinical Documentation Improvement. Works… more
- Molina Healthcare (FL)
- …and Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/ utilization review, and/or other utilization management ... clinical and non-clinical team activities to facilitate integrated, proactive utilization management , ensuring compliance with regulatory and accrediting… more
- Mayo Clinic (Jacksonville, FL)
- …patient plan of care throughout the continuum of care by ensuring appropriate utilization management , care coordination, resource utilization , and clinical ... outcomes. The RN Case Manager provides leadership through education on case management / utilization management concepts, committee work, research, and… more
- Evolent (Tallahassee, FL)
- …sources to establish and maintain the definitive source of truth for specialty Utilization Management (UM) agreements. This important work is achieved through ... Minimum 3 years of professional experience in value-based healthcare analytics or utilization management within a payer, provider, clinical vendor, managed care,… more
- Elevance Health (Tampa, FL)
- …information regarding case and determines appropriate area to refer or assign case ( utilization management , case management , QI, Med Review). + Provides ... reports and documents all actions. + Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical… more