- HCA Healthcare (Brooksville, 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
- Molina Healthcare (Tampa, FL)
- …of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. ... SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years… more
- CVS Health (Tallahassee, FL)
- …outcomes. * Leverage extensive knowledge of health care delivery system, utilization management , reimbursement methods and treatment protocols for DSNP/MMP ... Behavioral Health, Pharmacy, Member Outreach, Care Management , National Quality Management , Utilization Management , Compliance, and other departments to… more
- 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
- 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
- Elevance Health (Tampa, FL)
- …of 4 years managed care experience and requires a minimum of 2 years clinical, utilization review , or case management experience; or any combination of ... accommodation is granted as required by law. The **Medical Management Nurse** is responsible for review of...in multiple states. **Preferred Skills, Capabilities & Experiences:** + Utilization management experience. + Strong of computer… more
- AdventHealth (Palm Coast, FL)
- …of Nursing. + Health-related Master's degree or MSN. + Prior Care Management / Utilization Management experience. + ACM/CCM Certification. This facility ... Manager is under the general supervision of the Care Management Supervisor or Manager or Director of Nursing and...physicians and the interdisciplinary team on issues related to utilization of resources, medical necessity, CMS CoP for Discharge… more
- ChenMed (Jacksonville, 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
- AdventHealth (Winter Garden, FL)
- …qualifications:** + BSN or Health-related Master's degree or MSN + Prior Care Management / Utilization Management experience This facility is an equal ... patient satisfaction, patient safety, readmission prevention and length of stay management . The RN Care Manager communicates daily with the interdisciplinary team… more
- HCA Healthcare (Fort Walton Beach, FL)
- …Case Management is preferred + BSN is preferred + Certification in Case Management , Nursing or Utilization Review is preferred HCA Florida Fort ... with physicians, patients, families, hospital staff, and outside agencies + Performs utilization management reviews and communicates information to third party… more