- Prime Therapeutics (Tallahassee, FL)
- …community settings and Pharmacy benefit management (PBM) experience in clinical utilization management Every employee must understand, comply with and attest ... result + Demonstrated verbal, written communication, facilitation skills, conflict management , consensus building, problem solving, analytical skills, and creative… 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
- Devereux Advanced Behavioral Health (Viera, FL)
- **Description** Are you looking to advance your career in Admissions & Utilization Review ? If you answered yes, then consider joining our team where you can take ... your career to the next level. **Being the Utilization Review Coordinator at Devereux has its Advantages!** Devereux Florida is a nonprofit behavioral health… more
- BayCare Health System (Tampa, FL)
- …of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior/RN responsibilities include:** + Functions ... Nursing or Business **Experience:** + Required 2 years in Utilization Review or + Required 2 years...Review or + Required 2 years in Case Management or + Required 3 years Registered Nurse +… more
- Humana (Miramar, FL)
- …referral source and provider interactions and communications. Work with Pre-Authorization, Utilization Management , Billing, Pharmacy, Home Care and DME regarding ... follow established procedures for approving request or referring request for further review . Provide referral management education to members and providers… more
- HCA Healthcare (Gainesville, FL)
- …monitor and improve the patient flow program effectiveness as it relates to utilization review , resource management , and discharge planning and care ... hospitalists & PCP's to address and resolve issues related to facility utilization and patient flow process and facilitate strong working relationship between… more
- Highmark Health (Tallahassee, FL)
- …expertise.This may include updating/revising existing medical policies. + Partner with Utilization Management and other operational teams to identify ... by internal/external partners. Conducts peer reviews as part of the quality review process. In addition to policy ownership, the incumbent participates in various… more
- HCA Healthcare (Ocala, FL)
- …RN experience required + 4 year Bachelor Degree preferred. + Certification in Case Management or Utilization Review preferred HCA Florida Ocala Hospital is ... supporting a balance of optimal care and appropriate resource utilization . + Provides case management services for...apply for our RN Case Manager opening. We promptly review all applications. Highly qualified candidates will be contacted… more