- Centene Corporation (Tallahassee, FL)
- …Interact with network practitioners to provide education on best practice models and utilization management processes + Interact with the Medical Director, or ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- Humana (Tallahassee, FL)
- …. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, ...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Select Medical (Oxford, FL)
- …functions and professional growth of the department, including, but not limited to: Utilization Review (UR) and resource management , discharge planning, ... focus on resource management . + Demonstrating compliance with facility-wide Utilization Management policies and procedures. + Coordinating UR compliance with… more
- Cleveland Clinic (Port Saint Lucie, FL)
- …A caregiver in this role utilizes clinical expertise and understanding of utilization review requirements, discharge planning process, and Medicare regulations ... in the development of department practices and procedures for utilization review and discharge planning, ensuring compliance...state of employment. + 3 years of experience in utilization management , case management , or… 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
- Evolent (Tallahassee, FL)
- …the mission. Stay for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready ... on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… 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...member of the multidisciplinary team for case and disease management . They will advise the multidisciplinary team on cases,… more
- Molina Healthcare (St. Petersburg, FL)
- … and effective resource management . + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure ... IT and data analysts to produce tools to report, monitor and improve Utilization Management . + Actively participates in regulatory, professional and community… more
- Community Health Systems (Naples, FL)
- …**Qualifications** + 2-4 years of clinical nursing experience required + Experience in utilization review , case management , or discharge planning preferred ... Dental, Vision) **Job Summary** The Care Manager - LPN supports effective utilization management and discharge planning by coordinating patient care activities… more
- Elevance Health (Miami, FL)
- …diploma or equivalent, and a minimum of 2 years of clinical experience and/or utilization review experience. + Current active, valid and unrestricted LPN/LVN or ... Excel. + Previous clinical experience at a skilled nursing facility or utilization management experience strongly preferred. Please be advised that Elevance… more