- 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
- Humana (Tallahassee, FL)
- …and leadership during Medicare and Medicaid LOB - Medicare Clinical Criteria Review (MCCR), Utilization Management Committee (UMC), Medical Coverage Policy ... develop and maintain medical coverage policies utilizing an evidence based medicine review process. **Location:** work at home anywhere Humana is seeking a Senior… more
- ChenMed (Pembroke Pines, FL)
- …engagement with patient and family. + Facilitate patient/family conferences to review treatment goals, optimize resource utilization , provide family education ... assist in achieving desired clinical outcomes within specific timeframe. + Conducts review for appropriate utilization of services from admission through… more
- Molina Healthcare (Miami, FL)
- …that support one or more of the following activities: care review / utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.), ... case management, transition of care, health management and/or member assessment. * Typically through one or more direct report supervisors, facilitates integrated, proactive management, ensuring compliance with state and federal regulatory and accrediting… more
- Terracon (Winter Park, 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
- Terracon (West Palm Beach, 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
- Ensono (Miami, FL)
- …performance, reliability and consistency. + Increase efficiency through automation and/or template utilization as appropriate. + Review and seek out cost ... reductions, efficiency improvements and better methods to support applicable technology environments. + Keeps informed of latest industry, trends, products, services with relevant existing and emerging technologies. + Train and communicate with Associates and… more
- Terracon (Jacksonville, 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
- ChenMed (Opa Locka, FL)
- …engagement with patient and family. + Facilitates patient/family conferences to review treatment goals and optimize resource utilization ; provides family ... assist in achieving desired clinical outcomes within specific timeframe. + Conducts review for appropriate utilization of services from admission through… more
- Centene Corporation (Tallahassee, FL)
- …discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in ... health management systems according to utilization management policies and guidelines + Works with healthcare...or provide recommendations based on requested services and concurrent review findings + Assists with providing education to providers… more