- Highmark Health (Tallahassee, FL)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... and the proper action to complete the retrospective claim review with the goal of proper and timely payment...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
- Datavant (Tallahassee, FL)
- …healthcare. The purpose of the Denial Prevention Specialist is to effectively defend utilization of available health services, review of admissions for medical ... letter Identification of referrals to the medical director for review + Select appropriate preferred and contracted providers +...management Ideal candidate should be a Licensed Practical Nurse or Registered Nurse well versed in… more
- HCA Healthcare (Gainesville, FL)
- …monitor and improve the patient flow program effectiveness as it relates to utilization review , resource management , and discharge planning and care ... location._** It is an exciting time to be a nurse at HCA Healthcare! Come unlock your career potential...PCP's to address and resolve issues related to facility utilization and patient flow process and facilitate strong working… more
- BayCare Health System (Bradenton, FL)
- …bodies within the area of responsibility. + Ensure quality assurance program and utilization review is followed in accordance with Home Care protocol. + ... Oversees and investigates patient and physician concerns, risk management concerns and implements changes and training where necessary....Participates with Case Manager on initial Plan of Care review with a focus on quality, utilization … more
- BayCare Health System (Dunedin, FL)
- …regulatory bodies within the area of responsibility + Ensure quality assurance program and utilization review is followed in accordance with Home Care protocol + ... Oversees and investigates patient and physician concerns, risk management concerns and implements changes and training where necessary...Participates with Case Manager on initial Plan of Care review with a focus on quality, utilization … more
- HCA Healthcare (Jacksonville, FL)
- …Case Management is required for this PRN role. + Certification in Case Management or Utilization Review is preferred. + InterQual experience is ... you have the PRN career opportunities as a **Registered Nurse (RN) Case Manager** you want with your current...stay, managing the length of stay, ensuring appropriate resource management , while developing a safe appropriate discharge plan. +… more
- HCA Healthcare (Orange Park, FL)
- …Case Management is required for this PRN role.** + Certification in Case Management or Utilization Review is preferred. + InterQual experience is ... you have the PRN career opportunities as a **Registered Nurse (RN) Case Manager** you want with your current...stay, managing the length of stay, ensuring appropriate resource management , while developing a safe appropriate discharge plan. +… more
- Cleveland Clinic (Weston, FL)
- …to ensure compliance and strong performance across safety, quality, utilization and patient experience metrics and support implementation of requirements ... compliance with all standards and favorable performance on safety, quality, utilization , and experience metrics. + Participate in engraining the safety, quality,… more
- University of Miami (Miami, FL)
- …apply for a faculty or staff position, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The University ... The Manager, Nursing promotes and restores patients' health by developing day-to-day management and long-term planning of the patient care area, directing and… more
- HCA Healthcare (Orange Park, FL)
- …of experience in Case Management is highly preferred. + Certification in Case Management or Utilization Review is preferred. + InterQual experience is ... us apart from any other healthcare provider. We are seeking a **Registered Nurse (RN) Case Manager** to join our healthcare family. **Benefits** **HCA Florida Orange… more