- 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, ... physicians, patients, families, hospital staff, and outside agencies + Performs utilization management reviews and communicates information to third party payors +… more
- HCA Healthcare (Gainesville, FL)
- …and improve the patient flow program effectiveness as it relates to utilization review , resource management, and discharge planning and care coordination. ... hospitalists & PCP's to address and resolve issues related to facility utilization and patient flow process and facilitate strong working relationship between… more
- Highmark Health (Tallahassee, FL)
- …+ Participate in product specific Pharmacy and Therapeutics Committees and Drug Utilization Review (DUR) Committees as necessary or contractually required. + ... Participate in product specific government meetings as necessary. + Coordinate implementation of clinical programs and operational requirements as necessary. + Support product specific business retention and business development activities as necessary. +… more
- Battelle Memorial Institute (Tampa, FL)
- …within legal and professional parameters + Knowledge and skill in using pre-established utilization review criteria to recognize and report actual or potential ... will support positive programs for equal treatment of all staff and full utilization of all qualified employees at all levels within Battelle._ The above statements… more
- Humana (Tallahassee, FL)
- …Office products including Word, Excel and Outlook **Preferred Qualifications** + Utilization Review /Quality Management experience + Experience working with MCG ... guidance where needed. Follows established guidelines/procedures. **KEY ACCOUNTABILITIES** + Review medical documentation, obtain additional information that may be… more
- Elevance Health (Tampa, FL)
- …regarding case and determines appropriate area to refer or assign case ( utilization management, case management, QI, Med Review ). + Provides information ... reports and documents all actions. + Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical… more
- CenterWell (Daytona Beach, FL)
- …in patient experience, quality of care, clinical outcomes, and avoidable utilization *Periodically review clinician charts to identify opportunities in ... social determinants of health (SDOH) efforts, improving clinical outcomes and avoidable utilization *Monitor and manage daily patient care and initiatives to improve… more
- CenterWell (Jacksonville, FL)
- …performance in patient experience, quality of care, clinical outcomes, and avoidable utilization + Periodically review clinician charts to identify opportunities ... of health (SDOH) efforts, improving clinical outcomes and avoidable utilization + Monitor and manage daily patient care and...and monitor clinical & financial performance and metrics. + Review clinician schedules and incentive plans to align with… more
- Elevance Health (Miami, FL)
- …Medical Director** **Carelon Medical Benefits Management** **Radiology Benefit Management/ Utilization Review ** **Virtual:** This role enables associates ... decisions. + Brings to their supervisors attention, any case review decisions that require + Medical Director review... review decisions that require + Medical Director review or policy interpretation. **Minimum Requirements:** + Requires MD… 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 ... required by law. The **Medical Director-Dermatology Appeals** is responsible for the review of appeals for physical health medical services, to ensure the… more