- 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
- HCA Healthcare (Tallahassee, 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 ... and compliant** + **Certification in Case Management, Nursing, or Utilization Review , preferred** + **Three years of...Leon and Gadsden Counties. Our facilities include a state-of-the-art Behavioral Health Center, Cancer Center, Chest Pain… more
- HCA Healthcare (Tallahassee, FL)
- …position if current and compliant** + **Certification in Case Management, Nursing, or Utilization Review , preferred** + **Three years of nursing experience in ... include: + **Comprehensive benefits** for medical, prescription drug, dental, vision, behavioral health and telemedicine services + **Wellbeing support,**… 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 ... fee for service and assisting nurses as needed with review of claims. Works with other Medicare Administrative Contractor...For Health Solutions and Carelon organizations (including behavioral health ) only, minimum of 5 years… more
- BrightSpring Health Services (Gainesville, FL)
- …report any discrepancies to BM. + Run monthly End of Month reports. + Run and review Utilization - Work all over utilized clients to prevent SVPs. + Time Detail ... community living, adult host homes for adults regardless of disability, behavioral /mental health support, in-home pharmacy solutions, telecare and remote… more
- Veterans Affairs, Veterans Health Administration (Gainesville, FL)
- …to veteran patients according to the North Florida/South Georgia VA Health System mission and the Physical Medicine and Rehabilitation guidelines. Employees ... therapy interventions for treating patients with complex medical or mental health issues, such as polytrauma, traumatic brain injury (TBI), posttraumatic stress… more
- AdventHealth (Altamonte Springs, FL)
- …liaison between physicians and Case Management staff to optimize resource utilization , ultimately resulting in enhanced patient service, improved medical staff ... + Demonstrated track record of excellence in physician leadership roles within health systems or prominent medical groups. + Business acumen covering strategic… more
- Highmark Health (Tallahassee, FL)
- **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This role is responsible for designing, developing, implementing, supporting, and optimizing ... stakeholder concerns. **Key Responsibilities:** + Lead and participate in Architecture Review Board processes, providing expert guidance on cloud-based solutions and… more
- HCA Healthcare (Gainesville, 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 ... physical, psycho-social, financial). + Participates in IDT rounds, + Conducts utilization review , evaluates clinical information, and communicates findings to… more
- Highmark Health (Tallahassee, FL)
- **Company :** Highmark Health **Job Description :** Entirely Remote Work From Anywhere Role! We are seeking an experienced Software Engineering Manager to lead our ... have budgetary responsibility and authority. + Understand budget and resource utilization across the product teams. Escalate any issues regarding product delivery… more