- Elevance Health (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. + May conduct peer-to-peer clinical appeal case reviews with… 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
- BayCare Health System (Bradenton, 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
- Elevance Health (Tampa, 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 ... appeal case reviews with attending physicians or other ordering providers to discuss review determinations. + Serves as a resource and consultant to other areas of… more
- Elevance Health (Tampa, FL)
- …program, including Prior Authorizations, Medication Therapy Management (MTM), Lock-in, and Drug Utilization Review (DUR) programs. **How you will make an ... the Pharmacy and Therapeutics Committee including therapeutic class reviews, policy review , drug monographs, and formulary recommendations. + Develop strategies to… 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 (Dunedin, FL)
- …regulatory 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 **Required Experience:** + 2… more
- Elevance Health (Miami, FL)
- …diploma or equivalent, and a minimum of 2 years of clinical experience and/or utilization review experience. + Current active, valid and unrestricted LPN/LVN or ... Excel. + Previous clinical experience at a skilled nursing facility or utilization management experience strongly preferred. Please be advised that Elevance Health… more
- HCA Healthcare (Ocala, FL)
- …required + 4 year Bachelor Degree preferred. + Certification in Case Management or Utilization Review preferred HCA Florida Ocala Hospital is a 323-bed facility. ... throughput while supporting a balance of optimal care and appropriate resource utilization . + Provides case management services for both inpatient and observation… more
- HealthTrust Workforce Solutions (Bradenton, FL)
- …Case Managers to assure that the following functions of the role are completed: Utilization Review for medical necessity of admission and concurrent stay, Social ... and resource management, cost control, contract compliance, quality improvement, utilization management, denials management and management of relationships with… more