- HCA Healthcare - Chief Medical Officer (Bradenton, FL)
- …a data-driven environment of quality and cost improvement and develops systems to review utilization of resources and objectively measure outcomes of care in ... ongoing in-service programs to facility medical staff regarding clinical resource management , appropriate documents standards, utilization and quality issues,… more
- Monogram Health (Fort Myers, FL)
- …populations Experience with NCQA, HEDIS, Medicaid, Medicare, quality improvement, medical utilization management , and risk adjustment Current state medical ... and the seamless transitions to dialysis, pre-emptive kidney transplant, conservative management . The Regional Medical Executive is a key clinical leader within… more
- Elevance Health (Tampa, FL)
- …a clinical call center The **Manager Behavioral Health Services** is responsible for Behavioral Health Utilization Management (BH UM), or Behavioral ... cost of care initiatives. + May attend meetings to review UM and/or CM process and discusses facility issues....and/or outpatient psychiatric and chemical dependency treatment and prior utilization management experience; or any combination of… more
- Molina Healthcare (Miami, FL)
- …most effective setting while contributing to enterprise-wide strategies for integrated behavioral health programs, utilization management standardization, ... + Provides psychiatric leadership and clinical expertise for utilization management , case management , and integrated behavioral health/chemical… 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...Devereux has its Advantages!** Devereux Florida is a nonprofit behavioral health organization that provides a wide range of… more
- Highmark Health (Tallahassee, FL)
- …determination for prior authorization review and appeals. Through the Utilization Review system, the incumbent evaluates clinical information provided by ... prior authorization or appeals against medical policy through the Utilization Review system. Update the system records...job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …Experience in a managed care, case management , or utilization review setting + Strong understanding of behavioral health diagnoses, treatments, and ... + Participate in interdisciplinary case rounds, quality improvement initiatives, and utilization review processes. + Support members during transitions of… more
- Highmark Health (Tallahassee, FL)
- …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... and DOL regulations at all times. In addition to utilization review , the incumbent participates as the...member of the multidisciplinary team for case and disease management . They will advise the multidisciplinary team on cases,… more
- ChenMed (Tampa, FL)
- …will manage complex behavioral health patient issues by providing casework, utilization management and discharge planning services to promote the highest ... rapidly expanding and we need great people to join our team. The LCSW/ Behavioral Health Specialist assists, coordinates and manages the needs of the Behavioral… more
- HCA Healthcare (Tallahassee, FL)
- …in your career path, we encourage you to apply for our Manager Case Management opening. We review all applications. Qualified candidates will be contacted by ... you have the career opportunities as a(an) Manager Case Management you want in your current role? We invest...for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services… more
