- CVS Health (Tallahassee, FL)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... training.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health....lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
- Ascension Health (Pensacola, FL)
- …two (2) years of proven leadership or management experience, preferably overseeing Case Management or Utilization Review teams in an Acute Care setting. ... **Details** + **Department:** Case Management + **Schedule:** Full time Day Shift +...an annual bonus incentive As the Director of Case Management for our Acute Care Services, you will lead… 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
- Actalent (Miami, FL)
- …nurses to assist each other and complete cases. Qualifications: + 3+ years of utilization management , concurrent review , prior authorization, utilization ... Urgent Hiring for "Remote Clinical Review Nurses" Job Description: + Review approximately 20 cases a day for medical necessity. + Advocate for and protect… more
- ChenMed (Tampa, FL)
- …explain primary care provider role. + Facilitates patient/family conferences to review treatment goals, optimize resource utilization , provide family education ... re: goals of care, palliative care and hospice. + Utilization /Financial Management -managing resource utilization and...quality of health care. + Applies skills in peer review to promote a culture of excellence. + Anticipates… more
- Humana (Tallahassee, FL)
- …management + Utilization management experience in a medical management review organization such as Medicare Advantage, managed Medicaid, or Commercial ... The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The...with prior experience participating in teams focusing on quality management , utilization management , or similar… more
- Humana (Tallahassee, FL)
- …providers. + Utilization management experience in a medical management review organization, such as Medicare Advantage, Managed Medicaid, or Commercial ... + Demonstrate adaptability and willingness to learn evolving workflows, tools, and utilization management practices **Work Schedule Monday - Friday w/standard… more
- HCA Healthcare (Gainesville, FL)
- …Case Management is preferred + BSN is preferred + Certification in Case Management , Nursing or Utilization Review is preferred HCA Florida North Florida ... with physicians, patients, families, hospital staff, and outside agencies + Performs utilization management reviews and communicates information to third party… more
- HCA Healthcare (Gainesville, FL)
- …Case Management is preferred + BSN is preferred + Certification in Case Management , Nursing or Utilization Review is preferred HCA Florida North Florida ... with physicians, patients, families, hospital staff, and outside agencies + Performs utilization management reviews and communicates information to third party… more
- Humana (Tallahassee, FL)
- …health initiatives. + Collaborate with various operational functions in the centralized utilization management team and other shared services. + Participate in ... data (eg Quality measures, Risk Adjustment ratings, chronic condition management , PCP visit rates and effectiveness, and member engagement...quality governance, peer review , and grievance resolution processes. Innovation & Transformation: +… more