- 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
- 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
- Elevance Health (Tampa, FL)
- …supervision. **Preferred Skills, Capabilities and Experiences:** + Previous experience in case management / utilization management with a broad range of ... offers superior clinical mental health and substance use disorder management , a comprehensive employee assistance program, work/life support, specialty programs… more
- Elevance Health (FL)
- …or certification is a requirement for this position. + Previous experience in case management / utilization management with a broad range of experience with ... , offers superior clinical mental health and substance use disorder management , a comprehensive employee assistance program, work/life support, specialty programs… more
- Humana (Tallahassee, FL)
- …provisioning + EPIC analyst certification/accreditations as they related to business functions ( utilization management , care management , etc ) + Previous ... OR A Bachelor's degree - Areas of consideration are: Product Management , Health Informatics, Business, Computer Science, Engineering, or related + Strategic… more
- Elevance Health (Miami, FL)
- …supervision.) **Preferred Skills, Capabilities and Experiences:** + Previous experience in case management / utilization management with a broad range of ... We are a third-party administrator (TPA) of medical benefits, including medical management . **Hours: 8am-5pm (Local time)** The **Behavioral Health Care Manager I**… more
- Humana (Tallahassee, FL)
- …Policy Governance Professional 2 supports the ongoing development, review , and management of Utilization Management (UM) policies and procedures. This ... and continuous improvement initiatives. Responsibilities: + Assist with the development, review , and maintenance of UM policy and procedure documentation, ensuring… 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 directly… more