- Actalent (Orlando, FL)
- …Job Description This role involves utilizing clinical skills to perform utilization management reviews, including prior authorizations, coverage exceptions, and ... Clinical Review Pharmacist 100% Remote | Contract-to-Hire | Benefits...there is potential for long-term employment. Responsibilities + Conduct utilization management reviews such as prior authorizations… 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
- ChenMed (Tampa, FL)
- …+ LCSWs will manage complex behavioral health patient issues by providing casework, utilization management and discharge planning services to promote the highest ... patients to improve coordination of services and information flow. + Provides self- management support and ongoing phone contact with patients. + Coordinates, reviews… more
- 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 ... a State agency.*_ **Preferred Skills, Capabilities and Experiences:** + 1-2 years Utilization Management experience strongly preferred. + Strong oral, written,… more
- Prime Therapeutics (Tallahassee, FL)
- …Staff Pharmacist is responsible for the processing and documenting of Utilization Management requests (ie formulary exceptions, prior authorization, step ... for coverage determination requests for prior authorization (PA) or other utilization management (UM) programs, including quantity limits, step therapy,… more
- Sevita (FL)
- …states to increase census, maintain occupancy, improve daily attendance, and maximize utilization . + **Financial Management :** + Oversee billing to ensure ... opportunity to grow with a mission-driven organization** Do you have substantial management experience in human services? Are you looking for rewarding work in… more
- Molina Healthcare (FL)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. **Required Qualifications** * At ... **JOB DESCRIPTION** **Job Summary** Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically… more
- Molina Healthcare (Tampa, FL)
- JOB DESCRIPTION Job SummaryProvides non-clinical administrative support to utilization management team and contributes to interdisciplinary efforts supporting ... * Provides telephone, clerical and data entry support for the care review team. * Provides computer entries of authorization request/provider inquiries, such as… 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
- Centene Corporation (Tallahassee, FL)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more