- 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 ... for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services...PCP's to address and resolve issues related to facility utilization and patient flow process and facilitate strong working… more
- Highmark Health (Tallahassee, FL)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... and the proper action to complete the retrospective claim review with the goal of proper and timely payment...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… 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 ... for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services...supporting a balance of optimal care and appropriate resource utilization . + Provides case management services for… more
- HCA Healthcare (Tampa, FL)
- …guidelines. Participates in developing department goals and clinical programming. + Performs utilization review as assigned. + Helps with Process and Quality ... for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services...or experience in the area of clinical practice and/or management + Currently licensed as one of the following… more
- HCA Healthcare (Ocala, FL)
- …of day as assigned by Manager/Director. + First line resource to Case Managers, Utilization Review , and Medical Social Workers. Elevates issues as appropriate. + ... for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services...The Social Worker is part of the integrated Case Management Team who collaborates patients and their families to… more
- HCA Healthcare (Alachua, FL)
- …at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical ... assessments as directed + Manages multiple engagements concurrently, including: management of division laboratory activities, on site interviews, current state… more
- MyFlorida (St. Petersburg, FL)
- …process billing claims. + Enters Services and tracking process for Directions Behavioral Health program, review clinical notes match claims and authorization. ... referrals in accordance to the established Specialty Care medical grid(Radiology, Behavioral and other specialties) + Verifies County eligibility. + Generates… more
- HCA Healthcare (Kissimmee, FL)
- …at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical ... through clinical screenings and assessments in collaboration with both hospital Case Management and the Rehab Medical Director. Job Duties and Responsibilities: +… more
- HCA Healthcare (Kissimmee, FL)
- …at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical ... providers. The DPS II provides support to hospital facilities operations management related to physicians, including primary care, specialists, and subspecialists… more
- Highmark Health (Tallahassee, FL)
- …and financial stakeholders **Preferred** + Experience with medical policy and utilization management functions + Medical coding experience **LICENSES or ... both internally developed and vendor-sourced criteria. This includes proactive monitoring, review , and timely updates in response to new evidence, regulatory… more