- Molina Healthcare (Tampa, FL)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + Identifies and… more
- HCA Healthcare (Gainesville, FL)
- …is preferred + BSN is preferred + Certification in Case Management, Nursing or Utilization Review is preferred HCA Florida North Florida Hospital is a 523-bed, ... supporting a balance of optimal care and appropriate resource utilization . You would be part of a phenomenal team...for our RN Case Manager PRN opening. We promptly review all applications. Highly qualified candidates will be contacted… more
- ChenMed (Miami, FL)
- …experience in Hospital medicine preferred + At least one (1) year of utilization review experience preferred We're ChenMed and we're transforming healthcare for ... our team. The Physician Reviewer is the primary physician reviewer for Utilization Management/Clinical Appropriateness review cases in our organization. Other… more
- Ascension Health (Jacksonville, FL)
- …areas of responsibility, to include but not limited to; + Quality and Safety + Utilization Review + Peer Review and Credentialing + Growth and Strategic ... of services, policies, processes, and programs, including medical practice review , governance, credentialing, privileging, peer review , medical information… more
- Select Medical (Gainesville, FL)
- …and professional growth of the department, including, but not limited to: Utilization Review (UR) and resource management, discharge planning, treatment plan ... patient-specific, safe and timely discharge plan. + Performing verification of utilization criteria reviews. + Building relationships and coordinating with payor… more
- Adecco US, Inc. (Altamonte Springs, FL)
- …experience in an acute clinical care setting or equivalent. . Previous care management, utilization review or discharge planning experience. . RN License in FL . ... the cost consequences resulting from Care Management decisions through utilization of reports and systems such as Health Plan...of reports and systems such as Health Plan Benefits, utilization of metrics and CM reports. **Qualifications for the… more
- HCA Healthcare (Sanford, FL)
- …is preferred + BSN is preferred + Certification in Case Management, Nursing or Utilization Review is preferred HCA Florida Lake Monroe Hospital is a 221-bed ... and patient throughput while supporting a balance of optimal care and appropriate resource utilization . You would be part of a phenomenal team that works hard to… more
- HCA Healthcare (Brooksville, FL)
- …Healthcare Quality) OR CHCQM (Diploma in American Board of Quality Assurance and Utilization Review Physicians). _Individuals without CPHQ or_ CHCQM _will be ... our Director, you will provide direction to ensure the facilitation and utilization of diverse strategies and communication for quality and performance improvement… more
- Highmark Health (Tallahassee, FL)
- …NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the ... **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most… more
- Elevance Health (Miami, FL)
- …must 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 ... clinical reviews with attending physicians or other providers to discuss review determinations and patient's office visits with providers and external physicians.… more