- Elevance Health (FL)
- …& Analytics (RDA)** + **Cost of Care / Payment Integrity** + **Care Management / Utilization Management (CM/UM) Modernization** + **Provider Networking ... state or territory of the United States when conducting utilization review or an appeals consideration and...or healthcare leadership preferred. + Experience advising medical cost management , utilization management , payment integrity,… more
- AdventHealth (Orlando, FL)
- …documents avoidable days, and facilitates progression of care. Collaborates with Utilization Management staff for collaboration on patient status changes ... (as permitted by the patient) as well as a review of the current and past inpatient and outpatient...+ Health-related masters degree or MSN + Prior Care Management / Utilization Management experience +… more
- Molina Healthcare (Miami, FL)
- …member care. Essential Job Duties * Performs audits of non-clinical staff in utilization management , care management , member assessment, and/or other teams ... Required Qualifications * At least 2 years health care experience, preferably in utilization management , care management , and/or managed care, or equivalent… more
- Evolent (Tallahassee, FL)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators...Be Doing:** + Practices and maintains the principles of utilization management and appeals management … more
- HCA Healthcare (Sanford, FL)
- …in Case Management is preferred + BSN is preferred + Certification in Case Management , Nursing or Utilization Review is preferred HCA Florida Lake Monroe ... with physicians, patients, families, hospital staff, and outside agencies + Performs utilization management reviews and communicates information to third party… more
- ChenMed (Miami Gardens, FL)
- …day-to-day operations and strategic decisions. + Leads and develops projects focused on utilization management trends which help find insights in the data and ... quality, design, and implementation. This position aligns and oversees the management , development, and integration of data analytics and business intelligence… more
- HCA Healthcare (Sanford, FL)
- …in Case Management is preferred + BSN is preferred + Certification in Case Management , Nursing or Utilization Review is preferred HCA Florida Lake Monroe ... with physicians, patients, families, hospital staff, and outside agencies + Performs utilization management reviews and communicates information to third party… more
- HCA Healthcare (Kissimmee, FL)
- …and admission status issues through established chain of command. + Performs utilization management reviews and communicates to third party payors. + ... care, medical necessity, admission status, level of care, and resource management . Responsible for coordinating activities that promote quality outcomes and patient… more
- Ascension Health (Jacksonville, FL)
- …of recent work experience in a hospital setting, preferably with some Physician Advisory/ Utilization Management work experience. If you are ready to join a ... of care and length of stay determination. + Assist and manage the denial management process. + Review and offer suggestions related to resources and service… more
- HCA Healthcare (Largo, FL)
- …Healthcare Quality) OR CHCQM (Diploma in American Board of Quality Assurance and Utilization Review Physicians). _Individuals without CPHQ or_ CHCQM _will be ... of experience in a healthcare environment + Previous experience in accreditation, quality, utilization management , or risk management required. + Knowledge… more