- Evolent (Tallahassee, FL)
- …to adeptly negotiate internally and externally around interpretation and application of utilization review law, accreditation standards and policy. + Ensures ... **What You Will Be Doing:** + Responsible for oversight of utilization management (UM)/care management (CM) correspondence development, internal and external… more
- HCA Healthcare (Ocala, FL)
- …required + 4 year Bachelor Degree preferred + Certification in Case Management or Utilization Review preferred + 1 year experience in acute hospital with ... throughput while supporting a balance of optimal care and appropriate resource utilization . + Provides case management services for both inpatient and observation… 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
- AdventHealth (Land O' Lakes, FL)
- …for one another and respect for each persons unique contributions, provides utilization review care that is non-judgmental and non-discriminatory. Consider ... on a specific group of patients.The Case Manager is responsible for utilization reviews and resource management, discharge planning, treatment plan management and… more
- HCA Healthcare (Fort Walton Beach, FL)
- …is preferred + BSN is preferred + Certification in Case Management, Nursing or Utilization Review is preferred HCA Florida Fort Walton-Destin Hospital is a ... physicians, patients, families, hospital staff, and outside agencies + Performs utilization management reviews and communicates information to third party payors +… more
- AdventHealth (Altamonte Springs, FL)
- …Utilization Management, the Physician Advisor is responsible for providing clinical review of utilization , claims management, and quality assurance related to ... activities and program development + Provides guidance to clinical questions from Utilization Management staff involved in authorizations, concurrent review , and… 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 ... for Medicare fee for service and assisting nurses as needed with review of claims. Works with other Medicare Administrative Contractor (MAC) Medical Directors… more
- University of Miami (Miami, FL)
- …QI training + Improving patient satisfaction + Improving patient safety + Peer review , performance improvement, utilization review , root cause analysis, and ... faculty or staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The Department of… more
- Molina Healthcare (Tampa, FL)
- …abuse through the identification of aberrant coding and/or billing patterns through utilization review . + Prepares appropriate FWA referrals to regulatory ... and abuse. Duties include performing accurate and reliable medical review audits that may also include coding and billing...also entails producing audit reports for internal and external review . The position may also work with other internal… more
- The Hartford (Lake Mary, FL)
- …Understanding of PPD rules and requirements, claim management, case management, and/or utilization review methodology preferred + Excellent verbal and written ... the PPD Clinical Consultant will apply his/her medical expertise to review impairment ratings utilizing AMA and state-specific software supported guidelines. The… more