- Highmark Health (Tallahassee, FL)
- …Compliance Analyst is responsible for monitoring and analyzing medical and utilization management activities to ensure compliance with internal policies, state, CMS, ... to internal departments. The Analyst conducts audits of Medical Directors, Utilization Management (UM) and Case Management (CM) processes and files, delivering… more
- AdventHealth (Orlando, FL)
- …to nurses, physicians and the interdisciplinary team on issues related to utilization of resources, medical necessity, CMS CoP for Discharge Planning and care ... (as permitted by the patient) as well as a review of the current and past inpatient and outpatient...avoidable days, and facilitates progression of care. Collaborates with Utilization Management staff for collaboration on patient status changes… more
- Ascension Health (Jacksonville, FL)
- …recent work experience in a hospital setting, preferably with some Physician Advisory/ Utilization Management work experience. If you are ready to join a talented ... group of physicians apply today! **Responsibilities** : + Review medical records of identified patients to assist with the level of care and length of stay… more
- Evolent (Tallahassee, FL)
- …focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and procedures ... work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators...Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
- ChenMed (Tamarac, FL)
- …and explain primary care provider role. Facilitate patient/family conferences to review treatment goals, optimize resource utilization , provide family education ... Readmission Rate Advance directives/End of Life Planning Patient Satisfaction Utilization /Financial Management-managing resource utilization and reimbursement for… more
- Humana (Tallahassee, FL)
- …health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review ... of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Begins to influence department's… more
- University of Miami (Miami, FL)
- …or staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . Sr. Space ... and State agencies; gather, examine and analyze data related to research space utilization and productivity. + Conduct space audits, surveys and planning studies for… more
- Rep-Lite (Orlando, FL)
- …conditions. You will be responsible for expanding awareness, increasing treatment utilization in established accounts, and building a strong network of referring ... physicians, and care teams + Provide strategic support for multidisciplinary case review meetings to help identify eligible patients + Partner with cross-functional… more
- Humana (Tallahassee, FL)
- …health insurance, other healthcare providers, clinical group practice management + Utilization management experience in a medical management review organization, ... provider relations, quality of care, audit, grievance and appeal and policy review . The Behavioral Health Medical Director will develop and present educational… more
- Fujifilm (Tallahassee, FL)
- …identifying activities, sponsorships, and equipment needed to ensure success. + Review and consideration of event participation levels and requirements, involving ... key stakeholders as needed, and share with review committee for consideration. + Timely, proactive sharing and...data monitoring, analysis, summary, and report generation for sales utilization of Showpad materials and platform, including areas of… more