- Centene Corporation (Tallahassee, FL)
- …to ensure level of care and services are medically appropriate + Performs prior authorization reviews related to mental health and substance abuse to determine ... discharge planning + Analyzes BH member data to improve quality and appropriate utilization of services + Provides education to providers members and their families… more
- Molina Healthcare (Jacksonville, FL)
- …family include those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and ... and quality initiatives under the direction of leadership. + Monitors drug utilization and assists leadership team in understanding quality and cost control issues… more
- Monte Nido (Miami, FL)
- …while providing the opportunity for people to realize their healthy selves. ** Utilization Review Clinician** **Monte Nido** **Remote - EST or CST hours** **Monte ... to provide comprehensive care within an intimate home setting. The Utilization Review **Clinician** is responsible for conducting daily administrative and… more
- CVS Health (Tallahassee, FL)
- …day. **Position Summary** **Fully remote with requirement to reside in Florida.** + Utilization Management is a 24/7 operation and the work schedule may include ... in Florida + 3+ years of clinical experience + Utilization Management is a 24/7 operation and work schedule...(Teams, Outlook, Word, Excel, etc.) **Preferred Qualifications** + Previous prior authorization experience + Prefer RN FL Compact license… more
- Actalent (Orlando, FL)
- …validate the necessity and setting of care. Essential Skills + Proficiency in utilization management and utilization review + Experience with Interqual and ... Medicare + Expertise in medical, acute care, concurrent review, and prior authorization + Knowledge of managed care and patient care Additional Skills &… more
- CenterWell (Tallahassee, FL)
- …Nursing License + A minimum of three years clinical RN experience; + Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization ... procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare/Medicaid… more
- Molina Healthcare (St. Petersburg, FL)
- …standing. **Preferred Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and ... financial responsibility for Molina Healthcare and its members. May also perform prior authorization reviews and/or related duties as needed. + Processes requests… more
- Actalent (Oakland Park, FL)
- …+ Prior experience with pharmacy ACHC accreditation process preferred. + Prior utilization of QS1 software preferred. + PharmD qualification. + Strong ... cultural competency. Work Environment This role is 100% onsite in a high-volume, fast-paced clinic pharmacy located in Oakland Park, FL. The working hours are Monday to Friday, from 8:30 AM to 5:30 PM. The company offers 4% year-over-year merit increases and… more
- Actalent (Plantation, FL)
- …+ Preferred prior experience with pharmacy ACHC accreditation process. + Preferred prior utilization of QS1 software. Work Environment The role is 100% ... onsite in a high-volume, fast-paced clinic pharmacy located in Oakland Park, FL. The shift is Monday through Friday, 8:30 am to 5:30 pm. The position offers a comprehensive benefits package, including employer-funded STD, LTD, and Basic Life insurance, with… more
- Actalent (Plantation, FL)
- …+ Preferred prior experience with pharmacy ACHC accreditation. + Preferred prior utilization of QS1 software. + Strong cultural competency. Work Environment ... This position is 100% onsite in a high-volume, fast-paced clinic pharmacy located in Oakland Park, FL. The work hours are Monday to Friday, from 8:30 am to 5:30 pm. The employer funds STD, LTD, and Basic Life, while voluntary Life, Accident, Hospital, and… more