- HealthTrust Workforce Solutions (Bradenton, FL)
- …budget and resource management , cost control, contract compliance, quality improvement, utilization management , denials management and management of ... than 200,000 jobs nationwide. **_JOB SUMMARY_** The Interim Leader of Case Management Services is a Registered Nurse who participates as an active administrative… more
- Highmark Health (Tallahassee, FL)
- …This role supports the full application product lifecycle for **clinical and utilization management software** , with a specific focus on driving ... They function as a pivotal bridge, translating high-level **clinical and utilization management software** business needs into detailed technical requirements… more
- Molina Healthcare (Tampa, FL)
- …of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies ... the most appropriate care at the most effective setting. *Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and… 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
- Centene Corporation (Tallahassee, FL)
- …reside in Florida + Board certified in Pediatrics or Family Medicine + Utilization Management experience and knowledge of quality accreditation standards. + ... functions for the business unit. + Provides medical leadership of all for utilization management , cost containment, and medical quality improvement activities. +… more
- Highmark Health (Tallahassee, FL)
- …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... and DOL regulations at all times. In addition to utilization review, the incumbent participates as the physician member...member of the multidisciplinary team for case and disease management . They will advise the multidisciplinary team on cases,… more
- Wolters Kluwer (Tampa, FL)
- …efforts, prioritizing efforts and resources for assigned customer portfolio. + **Ongoing Utilization Management ** + Oversee and analyze customer utilization ... Engagement Manager plays a high-impact role in managing strategy and product utilization across the Wolters Kluwer Health's Clinical Decision Support & Provider… more
- Community Health Systems (Naples, FL)
- … is responsible for the planning, coordination, and oversight of care management services, including utilization review, discharge planning, and transitions of ... timely admission, or discharge decisions. + Prepares and delivers reports on utilization , care management performance, and variance from expected outcomes to… more
- Community Health Systems (Naples, FL)
- …+ Refers cases not meeting criteria to the Physician Advisor or Utilization Management Committee and ensures appropriate follow-up. + Identifies avoidable ... Life and disability insurance and more **Job Summary** The Director, Care Management is responsible for overseeing the implementation, development, and management… more
- Elevance Health (Tampa, FL)
- …center The **Manager Behavioral Health Services** is responsible for Behavioral Health Utilization Management (BH UM), or Behavioral Health Case Management ... facility-based and/or outpatient psychiatric and chemical dependency treatment and prior utilization management experience; or any combination of education and… more