- 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
- Elevance Health (Miami, 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
- Molina Healthcare (St. Petersburg, FL)
- …Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). **MULTI STATE / COMPACT… more
- Humana (Tallahassee, FL)
- …. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... 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
- Humana (Tallahassee, FL)
- …. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... skills, with prior experience participating in teams focusing on quality management , utilization management , case management , discharge planning and/or… more
- Community Based Care of Brevard, Inc. (Brevard, FL)
- …Position Summary: This position is responsible for the clinical coordination, utilization management , and authorization of initial and ongoing services ... alternative funding sources whenever possible. The position facilitates Team Review Meetings and the utilization review...the most efficient and effective use of agency resources. Utilization Management - Essential Function: Ensure that… more
- Humana (Tallahassee, FL)
- …. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , discharge… more
- Highmark Health (Tallahassee, FL)
- …triaging members to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, ... Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or… more