- Molina Healthcare (Tampa, FL)
- …plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. ... Experience Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG… more
- Humana (Hallandale Beach, FL)
- …ensure interaction between the company and members are optimized. The Telephonic Behavioral Health Care Manager Internship provides transitioning service members ... optimal wellness state in a remote telephonic environment. The Behavioral Health Care Manager guides members and/or...health issues. + Monitor and maintain awareness of utilization and conducts outreach based on acuity to assess… more
- Molina Healthcare (FL)
- …facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need ... or ER unit. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). To all current Molina employees: If… more
- Highmark Health (Tallahassee, FL)
- …drug utilization reports, and write drug monographs for Committee review to develop the Organization's Drug formulary and/OR provide recommendations for NDC ... and stakeholders across the organization. Key responsibilities will include clinical review , assisting in navigating a complex regulatory environment, working with… more
- CVS Health (Tallahassee, FL)
- …other clinical services that are evidence-based. * Work collaboratively with the Behavioral Health , Pharmacy, Member Outreach, Care Management, National Quality ... to improve health outcomes. * Leverage extensive knowledge of health care delivery system, utilization management, reimbursement methods and treatment… more
- CVS Health (Tallahassee, FL)
- …to influence appropriate member care. . Attends and participates in case rounds, including utilization management rounds for behavioral health and physical ... coordinating all care management activities with members to evaluate the medical and behavioral health needs to facilitate the member's overall wellness. .… more
- MyFlorida (Monticello, FL)
- …Identifies students at risk for pregnancy, STDs, substance abuse, and social and behavioral health issues. Refers those students in need of further care. ... acute and emergency care to ill/injured students; identification of social, behavioral , economic, and medical health risks; medication administration; operation… more
- HCA Healthcare (West Palm Beach, FL)
- …services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed ... in developing department goals and clinical programming. + Performs utilization review as assigned. + Helps with...a 280-bed acute care facility. We have a 124-bed behavioral health unit. We are located in… more
- Highmark Health (Tallahassee, FL)
- **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This job works collaboratively riskacross Highmark Health clinical areas to support clinical ... Compliance Analyst is responsible for monitoring and analyzing medical and utilization management activities to ensure compliance with internal policies, state, CMS,… 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 ... conduct. Ensures adherence and completion of medical staff decisions regarding peer review and physician behavioral issues. + Leads the development of… more