- HCA Healthcare (Gainesville, FL)
- …guidelines. Participates in developing department goals and clinical programming. + Performs utilization review as assigned. + Helps with Process and Quality ... apply for our Mental Health Professional III Lic PRN opening. We promptly review all applications. Highly qualified candidates will be directly contacted by a member… more
- BayCare Health System (Plant City, FL)
- …staff's mutual interests and responsibility for quality assurance, appropriate utilization review , process improvement teams, credentialing and appointment ... of physicians. + Acts as an advocate of health system and medical staff interests with external payers, accreditors and regulatory agencies and will coordinate the development of documentation and presentation to support the health system and medical staffs… more
- NHS Management, LLC (Daytona Beach, 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
- ChenMed (Miami, FL)
- …responsible for the daily dispensing of medication, prospective and retrospective drug utilization review and patient counseling. The Incumbent will participate ... in Medication Therapy Management and additional clinical roles as needed including Anticoagulation Clinic. **ESSENTIAL JOB DUTIES/RESPONSIBILITIES:** + Prepares medications by reviewing and interpreting physician orders and detecting therapeutic… more
- Humana (Tallahassee, FL)
- …with medical terminology and/or ICD-10 codes. + Member service + Experience with Utilization Review and/or Prior Authorization, preferably within a managed care ... organization. **Additional Information** **Language Proficiency Testing** Any Humana associate who speaks with a member in a language other than English must take a language proficiency assessment, provided by an outside vendor, to ensure competency.… more
- Cognizant (Tallahassee, FL)
- …experience. * Experience in the analysis and processing of claims for payments, utilization review /quality assurance procedures. * Must be able to work with ... minimal supervision. * Good skills at problem resolution specifically related to healthcare claim adjudication. * Possess ability to work at a computer for extended periods. * Can work closely with other departments **Required Education and Experience** . High… 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
- CVS Health (Lakeland, FL)
- …your understanding of patient safety and error prevention, quality assurance drug utilization review (DUR), pharmacy professional standards such as corresponding ... responsibility and red flag detection. While in the pharmacy, you will assist the pharmacy team to ensure that pharmacy operations run smoothly, our patients' prescriptions are filled promptly, safely, and accurately, and we are providing caring service that… more
- CVS Health (Tallahassee, FL)
- …providers. As a Medical Director you will + Focus primarily on overseeing utilization review / quality assurance and be responsible for predetermination reviews ... and reviews of claim determinations. + This includes Prior Authorization / Pre Certification / Concurrent Reviews / Peer to Peer Calls / First Level Appeals / Special Projects and Committee participation when needed. + The Medical Director will provide… more
- Houston Methodist (FL)
- …caring for adults in an acute care hospital setting + Coding and utilization review experience preferred **LICENSES AND CERTIFICATIONS - REQUIRED** + RN ... - Registered Nurse - Texas State Licensure -- Compact Licensure - Must obtain permanent Texas license within 60 days (if establishing Texas residency) **LICENSES AND CERTIFICATIONS - PREFERRED** + CCDS - Clinical Documentation Specialists (ACDIS) **OR** + CDIP… more