- Actalent (Orlando, FL)
- …ensure the successful completion of cases. Essential Skills + Experience in utilization management , concurrent review, prior authorization, utilization ... + Active Compact RN License, Compact LPN is okay too + Utilization Management /Concurrent Review experience. + ICU/ER experience. + Strong communication… more
- Matrix Providers (Jacksonville, FL)
- …TRICARE directives, coordinating with the local Medical Home Port (MHP) clinic, utilization and Referral Management policies, and obtains additional clinical ... LPN/LVN - Pain Management Location: Jacksonville, FL, United States Healthcare Provider...a pattern of high risk, unstable and resource intensive utilization of Military Treatment facility (MTF) or network services… more
- Molina Healthcare (St. Petersburg, FL)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... / MCG guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). **MULTI STATE / COMPACT… more
- ChenMed (Miami, FL)
- …our team. The Physician Reviewer is the primary physician reviewer for Utilization Management /Clinical Appropriateness review cases in our organization. Other ... Process and Quality improvement in our developing area of Delegated Utilization Management . **ESSENTIAL JOB DUTIES/RESPONSIBILITIES:** + Provides Delegated… more
- CVS Health (Tallahassee, FL)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... residence.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health....lower levels of care. + 1+ years' experience in Utilization Review. + CCM and/or other URAC recognized accreditation… more
- Humana (Tallahassee, FL)
- …interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , discharge ... Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management + Utilization management experience in a… more
- CVS Health (Tallahassee, FL)
- …outcomes. * Leverage extensive knowledge of health care delivery system, utilization management , reimbursement methods and treatment protocols for DSNP/MMP ... Health, Pharmacy, Member Outreach, Care Management , National Quality Management , Utilization Management , Compliance, and other departments to integrate… more
- Highmark Health (Tallahassee, FL)
- …Risk Compliance Analyst is responsible for monitoring and analyzing medical and utilization management activities to ensure compliance with internal policies, ... guidance to internal departments. The Analyst conducts audits of Medical Directors, Utilization Management (UM) and Case Management (CM) processes and files,… more
- AdventHealth (Orlando, FL)
- …role you'll contribute:** The Population Health Case Manager (PHCM) ensures effective utilization and case management oversight activities as defined by inter ... best practices, agency policies/processes. Ensures clear and appropriate visit utilization using evidence-based and best practice guidelines to achieve positive… more
- Molina Healthcare (Tampa, FL)
- …comply with CMS guidelines. These staff may also be involved in providing utilization management /prior authorization services as needed. * Supervises the unit's ... (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management ), clinical pharmacy… more