- Evolent (Tallahassee, FL)
- …Doing:** As a Cardiology, Field Medical Director 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
- Evolent (Tallahassee, FL)
- …As a Vascular Surgery, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality… more
- HCA Healthcare (Bradenton, FL)
- …issues. Offers clinical support for appeals and denials process, discharge planning, case management , and utilization review / management . + Consults with ... of quality and cost improvement and develops systems to review utilization of resources and objectively measure...facility-level staff regarding delegated utilization management and disease management operations under managed… more
- Molina Healthcare (Orlando, FL)
- …contributing to enterprise-wide strategies for integrated behavioral health programs, utilization management standardization, and cost-effective quality outcomes ... multi-state region. + Provides psychiatric leadership and clinical expertise for utilization management , case management , and integrated behavioral… more
- Adecco US, Inc. (Tallahassee, FL)
- …hire if compact) + APRN license accepted if current and compliant + Case Management , Nursing, or Utilization Review certification preferred **Benefits** + ... its Case Management team. This role focuses on care coordination, utilization management , patient throughput, and discharge planning across the continuum of… more
- Evolent (Tallahassee, FL)
- …**What You'll Be Doing:** As a FMD, Radiology you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality… more
- 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