- NHS Management, LLC (West Melbourne, 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
- Cleveland Clinic (Port Saint Lucie, FL)
- …of eligibility (CTM, ACM, CCM or AHA) + Two years of recent experience in utilization review , quality or care management + Knowledge of acute care and ... accreditation requirements + Experience in discharge planning and quality improvement Our caregivers continue to create the best outcomes for our patients across each of our facilities. Click the link and see how we're dedicated to providing what matters most… more
- HCA Healthcare (Aventura, FL)
- …or 2 years of critical care experience + Certification in case management or utilization review preferred + InterQual experience preferred + This position may be ... eligible for a Sign-On Bonus 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… more
- CenterWell (Tallahassee, FL)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work… more
- Wolters Kluwer (Tampa, FL)
- …expectations and conducts project profitability, revenue, margins, bill rates and utilization analyses. + Review and ensure documentation/deliverables prepared ... by the internal team are following internal policy. + Responsible for communicating with stakeholders, including clients, management, and team members, to ensure everyone is on the same page. + Responsible for ensuring client satisfaction. + Report, evaluate,… more
- Highmark Health (Tallahassee, FL)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... care services, application of criteria to ensure appropriate resource utilization , identification of opportunities for referral to a Health Coach/case management,… more
- Elevance Health (Miami, FL)
- …documents to convey the determination. + Responsibilities exclude conducting any utilization or medical management review activities which require the ... response in clear, understandable language. + Utilizes guidelines and review tools to conduct extensive research and analyze the...summarize and route to nursing and/or medical staff for review . + The grievance and appeal work is subject… more
- Molina Healthcare (Jacksonville, FL)
- …team supporting non-clinical healthcare services activities for care management, care review , utilization management, transitions of care, behavioral health, ... within Molina's clinical/healthcare services function, which may include care review , care management, and/or correspondence processing, etc. * Researches and… more
- Southland Holdings (Lake Worth, FL)
- …to increase productivity + Review projects to focus on equipment and manpower; review job costs and equipment utilization reports. Plan and review ... Estimators and Superintendents. + Check equipment to monitor for repairs, utilization , abuse or neglect. + Participate in safety-related training programs to… more
- Terracon (Sarasota, FL)
- …operations of a department including staff training, development, and performance review , utilization of equipment and facilities, safety oversight, quality ... of services and work product, timely delivery of services and deliverables, and adherence to policies and procedure. Plan for and participate in business development activities to identify, develop, win, and execute project opportunities and build and maintain… more