- MyFlorida (Tallahassee, FL)
- …rules, coverage policies, managed care plan contracts, bill analyses, drug utilization review boards, preferred drug lists, supplemental rebate contracts, ... be found on the Agency's administrative rule webpage at http://ahca.myflorida.com/medicaid/ review /index.shtml. 8. Providing technical assistance to ensure consistency in… more
- NHS Management, LLC (Crystal River, FL)
- …of subordinate nurses engaged in quality assurance, infection control, and utilization review activities. + Receives physicians' instructions regarding resident ... care and ensures that orders are transmitted to other units as needed. + Oversees delegation of nursing and other therapeutic procedures to other level professionals and paraprofessional associates. + Makes regular patient rounds to observe and assess… more
- Deloitte (Tampa, FL)
- …nurse, physician, physician assistant, case manager, clinical documentation specialist, utilization review , informatics RN, Quality, DRG Validation and ... health IT preferred + Knowledge of Medicare reimbursement system and coding structures preferred + In-depth knowledge and experience in medical terminology, medical coding, and ICD-10-CM/PCS, IPPS payment system is a plus' + Experience in quality measurement,… more
- HCA Healthcare (Trinity, FL)
- …Healthcare Quality) OR CHCQM (Diplomate in American Board of Quality Assurance and Utilization Review Physicians) _Individuals without CPHQ or ABQUARP will be ... granted a 12 month grace period to obtain CPHQ or ABQAURP , if all other qualifications are met_ .CPPS (Certified Professional in Patient Safety) preferred .Minimum 5 years of experience .Knowledge of State, Federal, and TJC regulations. .Previous experience… more
- HCA Healthcare (Fort Walton Beach, FL)
- …guidelines. Participates in developing department goals and clinical programming. + Performs utilization review as assigned. + Helps with Process and Quality ... Improvement initiatives. **What qualifications you will need:** + Basic Cardiac Life Support must be obtained within 30 days of employment start date + Nonviolent Crisis Intervention must be obtained within 90 days of employment start date + Other-Fingerprint… more
- HCA Healthcare (Aventura, FL)
- …2 years of critical care experience + Certification in case management or utilization review preferred + InterQual experience preferred HCA Florida Aventura ... Hospital is 467-bed hospital. We are a fully accredited medical surgery hospital. We leverage the latest technologies and treatment protocols to meet healthcare needs. HCA Florida Aventura Hospital is designated a Level II Trauma Center. This is awarded by the… more
- Houston Methodist (FL)
- …caring for adults in an acute care hospital setting is required; coding and utilization review experience preferred + For Medical School graduate - One year ... of clinical experience preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN - Registered Nurse - Texas State Licensure and/or Compact State Licensure within 60 days **OR** + RN-Temp - Registered Nurse - Temporary State Licensure within 60 days + CCDS -… more
- CVS Health (Tallahassee, FL)
- …consistent responses to members and providers. Leads all aspects of utilization review /quality assurance, directing case management Provides clinical expertise ... and business direction in support of medical management programs through participation in clinical team activities. Acts as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs… more
- HCA Healthcare (Tamarac, FL)
- …or 2 years of critical care experience Certification in case management or utilization review preferred + InterQual experience preferred Founded in 1974, HCA ... Florida Woodmont Hospital is a 317-bed acute care hospital. We offer a wide range of surgical and medical services. We have distinguished ourselves as a pioneer in breakthroughs in orthopedic care as well as joint replacement. We continue to build on this… more
- HCA Healthcare (Miami, FL)
- …2 years of critical care experience + Certification in case management or utilization review preferred + InterQual experience preferred HCA Florida Kendall ... Hospital is located in west Miami-Dade County. Our acute care facility has 417-beds. Our services include trauma, burn, surgical, women's and children's services, behavioral health and diagnostic services. We have two full service free-standing ER facilities.… more