- Molina Healthcare (St. Petersburg, FL)
- …role must complete courses required to obtain licensure in all states. + Utilization Review Lead responsibilities also include but not limited to, collaborate ... timely completion. + Actively participates in the Department auditing program to review and communicate findings with staff and identify opportunities for improved… more
- Centene Corporation (Tallahassee, FL)
- …providers on the health plan's pharmacy process + Assist with the pharmacy utilization review and reporting process + Collaborate with Quality Improvement ... pharmacy calls regarding the prior authorization and formulary process + Perform review of pharmacy and override process in compliance with pharmaceutical related… more
- Centene Corporation (Tallahassee, FL)
- …providers on the health plan's pharmacy process + Assist with the pharmacy utilization review and reporting process + Collaborate with Quality Improvement ... pharmacy calls regarding the prior authorization and formulary process + Perform review of pharmacy and override process in compliance with pharmaceutical related… more
- AdventHealth (Daytona Beach, FL)
- …& Decision Support. Serves as regional executive liaison with Revenue Cycle, Utilization Review , Case Management, Supply Chain, Managed Care, Corporate ... Oversee functions directed by centralized division services such as Patient Access, Utilization Review , Case Management, Patient Financial Services, HIM, Coding,… more
- MTC (Graceville, FL)
- …improvement committee. 7. Closely monitor all potential catastrophic events and perform utilization review and tracking. 8. Submit and implement recommendations ... Monitor delivery of mental health care, audit patient records, review and complete monthly statistical reports, analyze, distribute, and...for improvements in services and optimal utilization of staff. 9. Develop and monitor effectiveness of… more
- HCA Healthcare (Gainesville, FL)
- …physical, psycho-social, financial). 1. Participates in IDT rounds, 1. Conducts utilization review , evaluates clinical information, and communicates findings to ... and payors on a timely basis in accordance with the NFRMC Utilization Review Plan and managed care contractual agreements. 1. Submits clinical information to… more
- MTC (Quincy, FL)
- …improvement committee. + Closely monitor all potential catastrophic events and perform utilization review and tracking. + Submit and implement recommendations ... + Monitor delivery of mental health care, audit patient records, review and complete monthly statistical reports, analyze, distribute, and discuss findings… more
- Highmark Health (Tallahassee, FL)
- …designs, competitive position, product development, network options, strategic partnerships, utilization review , local/national client demographics and dentist ... confidentiality agreements. Monitor financial performance of contracts by tracking utilization and competitive environment, including group specific performance guarantees.… more
- BayCare Health System (Sarasota, FL)
- …bodies within the area of responsibility. + Ensure quality assurance program and utilization review is followed in accordance with Home Care protocol. + ... + Participates with Case Manager on initial Plan of Care review with a focus on quality, utilization and individual patient care goals. + Knowledge of regulatory… more
- YesCare Corp (Tallahassee, FL)
- …measures including sentinel event review + Actively participant of the Utilization Review process and follow proper procedures. + Follows standard ... and paraprofessional staff. + Ensure and provide on-call services. + Annually review and approve clinical protocols, policies and procedures, and medical disaster… more