- Centene Corporation (Tallahassee, FL)
- …management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , quality ... physician education with respect to clinical issues and policies. + Identifies utilization review studies and evaluates adverse trends in utilization of… more
- Community Health Systems (Naples, FL)
- …collaborative care planning. + Ensures accurate and timely documentation of utilization review , discharge planning activities, and patient interactions in ... + 2-4 years of clinical nursing experience required + Experience in utilization review , case management, or discharge planning preferred **Knowledge, Skills… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …+ Minimum 5-10 years of progressively responsible experience in medical management, or utilization review within a healthcare plan, ACO, or provider system. + ... leadership, and oversight of all medical management functions, including Utilization Management, and Quality Improvement initiatives. This role ensures effective… more
- Evolent (Tallahassee, FL)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... the mission. Stay for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to make a… more
- Elevance Health (Miami, FL)
- …clients/ members. The medical director provides clinical expertise in all aspects of utilization review and case management. Provides input on the clinical ... be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military… more
- University of Miami (Miami, FL)
- …of UMHC SCCC Business Operations has an exciting opportunity for a full time Utilization Review Case Manager to work to work remote. The incumbent conducts ... initial, concurrent and retrospective chart reviews for clinical utilization and authorization. The Utilization Review...reviews for clinical utilization and authorization. The Utilization Review Case Manager coordinates with the… more
- HCA Healthcare (Port St. Lucie, FL)
- …a data-driven environment of quality and cost improvement and develops systems to review utilization of resources and objectively measure outcomes of care in ... for appeals and denials process, discharge planning, case management, and utilization review /management. + Consults with facility-level staff regarding delegated… more
- Evolent (Tallahassee, FL)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... Director you will be a key member of the utilization management team. We can offer you a meaningful...rationale for standard and expedited appeals. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
- Evolent (Tallahassee, FL)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... Director you will be a key member of the utilization management team. We can offer you a meaningful...the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
- Elevance Health (Miami, FL)
- …Plans, Freedom Health, and Optimum Healthcare Plans and will be responsible for utilization review case management for these markets. May be responsible for ... be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military… more