- Elevance Health (FL)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... Qualifications:** + Internal Medicine, or Family Medicine specialties preferred. + Utilization Management or Appeals experience preferred. For candidates working… more
- Humana (Tallahassee, FL)
- …health first** The UM Administration Coordinator 2 contributes to administration of utilization management . The UM Administration Coordinator 2 performs varied ... member service or customer service telephone experience desired + Experience with Utilization Review and/or Prior Authorization, preferably within a managed care… more
- Community Based Care of Brevard, Inc. (Orlando, FL)
- …and a web-based application for daily entry of case activity and the utilization management of service authorizations. 2+ years of Team Facilitation Skills ... coordinator will actively participate in, and facilitate, as needed, Local Review Teams and other applicable staffings/meetings. They will document activities and… more
- Prime Therapeutics (Tallahassee, FL)
- …and timely fashion. + Demonstrates the value of pharmacy solutions (unit cost, utilization management & patient care enhancement). + Identifies opportunities for ... cost solutions that meet the desired outcomes of the customer; general management of the account, including P&L responsibility; and accountability for contract… more
- Travelers Insurance Company (Tallahassee, FL)
- …skills **What is a Must Have?** + Licensed MD + 5 years clinical and utilization management experience + Certified by the American Board of Medical Specialties ... to keep Travelers at the leading edge of the P&C industry. Develop medical management strategies that help injured employees return to work as soon as medically… more
- Community Health Systems (Naples, FL)
- Join us as a **Registered Nurse (RN) - Utilization Review position** at Physicians Regional Collier Unit: Utilization Review Shift: Mon-Fri (this is an ... 401k match & more available for Full and Part-Time roles **Job Summary** The Utilization Review Nurse - RN reviews hospital admissions, extended stays, and… more
- Molina Healthcare (Orlando, FL)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. JOB DESCRIPTION Job SummaryProvides support for clinical member… more
- MTC (Graceville, FL)
- …record or other forms as appropriate. + Practice basic cost containment and utilization management for inmate care and facility operations. + Maintain absolute ... HIPAA rules. + Accurately and promptly chart medical care. Review medical files to determine all provided services are...with an acceptable driving record required, unless waived by management . Management & Training Corporation (MTC) is… more
- MTC (Graceville, FL)
- …record or other forms as appropriate. + Practice basic cost containment and utilization management for inmate care and facility operations. + Maintain absolute ... HIPAA rules. + Accurately and promptly chart medical care. Review medical files to determine all provided services are...with an acceptable driving record required, unless waived by management . Management & Training Corporation (MTC) is… more
- Prime Therapeutics (Tallahassee, FL)
- …specific clinical programs and drug strategy recommendations including drug formulary, Utilization Management programs, and other drug therapy related products ... stakeholders through effective consultative services. **Responsibilities** + Coordinate formulary management for the client including, client specific Pharmacy &Therapeutics… more