- AdventHealth (Daytona Beach, FL)
- …or Social Worker: BSW Masters in related field + 3 years in direct Care Management / Utilization Management experience in an acute care setting. + State ... Daytona Beach, 32117 **The role you'll contribute:** The Care Management Manager is under the general leadership of the...specific RN license if a nurse . **Preferred qualification:** + Registered Nurse : BSN… more
- AdventHealth (Sebring, FL)
- …or Social Worker: BSW Masters in related field. . 3 years in direct Care Management / Utilization Management experience in an acute care setting. . State ... and hiking trails **The role you'll contribute:** The Care Management Manager is under the general leadership of the...specific RN license if a nurse . . Licensed Social Worker (LSW) This facility is… more
- AdventHealth (Orlando, FL)
- …documents avoidable days, and facilitates progression of care. Collaborates with Utilization Management staff for collaboration on patient status changes ... State of Florida or multistate license as a Registered Nurse + 2 years of medical/ hospital nursing...+ Health-related masters degree or MSN + Prior Care Management / Utilization Management experience +… more
- Molina Healthcare (Tampa, FL)
- …Chief Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + ... as may be required. + Serves as a clinical resource for Utilization Management , Chief Medical Officer, Physicians, and Member/Provider Inquiries/Appeals. +… more
- HCA Healthcare (Tallahassee, FL)
- …is acceptable for position if current and compliant** + **Certification in Case Management , Nursing , or Utilization Review, preferred** + **Three years ... location._** It is an exciting time to be a nurse at HCA Healthcare! Come unlock your career potential...observation patients for appropriateness in observation status + Performs utilization management reviews and communicates information to… more
- Evolent (Tallahassee, FL)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company policies and… more
- Molina Healthcare (Tampa, FL)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... Experience using PEGA **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). MULTI STATE / COMPACT… 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 ... or Maternity/ Obstetrics experience . **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator or nurse… more
- AdventHealth (Orange City, FL)
- …of Nursing . + Health-related Master's degree or MSN. + Prior Care Management / Utilization Management experience. + ACM/CCM Certification. This facility is ... Manager is under the general supervision of the Care Management Supervisor or Manager or Director of Nursing...need to succeed:** **Minimum qualifications** : + Associate's degree Nursing or RN Diploma degree. + Registered Nurse… more
- ChenMed (Tamarac, FL)
- …Readmission Rate Advance directives/End of Life Planning Patient Satisfaction Utilization /Financial Management -managing resource utilization and ... setting. EDUCATION AND EXPERIENCE CRITERIA: + ARNP or similar advanced degree in Nursing required + Current Nurse Practitioner Certification in the State of… more