- Evolent (Tallahassee, FL)
- …Doing:** As a Field Medical Director, Oncology, you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality… more
- RxBenefits (Jacksonville, FL)
- …channel management , B/G classifications, specialty designations, rebate eligibility, utilization trend, Utilization Management (UM) implications, ... prospect member size, marketing agreements, broker commissions, and drug utilization . + Be the SME on dozens of medical...closed won groups into a client record for Account Management (AM) and Implementation including the initial gathering of… more
- Molina Healthcare (Jacksonville, FL)
- …learn new programs. Preferred Qualifications * Experience with utilization /quality program management . * Managed care experience. * Peer review experience. * ... health oversight and clinical leadership for health plan and/or market specific utilization management and care management behavioral health programs… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …nursing experience, including behavioral/mental health + Experience in a managed care, case management , or utilization review setting + Strong understanding ... + Participate in interdisciplinary case rounds, quality improvement initiatives, and utilization review processes. + Support members during transitions of… more
- HCA Healthcare (Tallahassee, FL)
- …is acceptable for position if current and compliant** + **Certification in Case Management , Nursing, or Utilization Review , preferred** + **Three years ... and assess observation patients for appropriateness in observation status + Performs utilization management reviews and communicates information to third party… more
- HCA Healthcare (Tallahassee, FL)
- …is acceptable for position if current and compliant** + **Certification in Case Management , Nursing, or Utilization Review , preferred** + **Three years ... and assess observation patients for appropriateness in observation status + Performs utilization management reviews and communicates information to third party… more
- HCA Healthcare (Tallahassee, FL)
- …is acceptable for position if current and compliant** + **Certification in Case Management , Nursing, or Utilization Review , preferred** + **Three years ... and assess observation patients for appropriateness in observation status + Performs utilization management reviews and communicates information to third party… more
- HCA Healthcare (Kissimmee, FL)
- …monitor and improve the patient flow program effectiveness as it relates to utilization review , resource management , and discharge planning and care ... educational leader to physicians and employees as it relates to utilization review , resource management , patient flow, multi-disciplinary rounds and hospital… more
- Humana (Tallahassee, FL)
- …of program changes and outcomes. Responsibilities include: + Oversee the development, review , and maintenance of Utilization Management (UM) policies ... complexity ranging from moderate to substantial. The Policy Governance Lead for Utilization Management (UM) is responsible for overseeing the development,… more
- Elevance Health (Tampa, FL)
- …Healthsun Plans, Freedom Health, and Optimum Healthcare Plans and will be responsible for utilization review case management for these markets. May be ... a State agency. **Preferred Qualifications:** + Bilingual- Spanish speaking preferred. + Utilization Management case review experience strongly preferred. +… more