- ChenMed (Tampa, FL)
- …Proven working experience in Case Management: + A minimum of 2 years' utilization review and/or case management, home health and/or discharge planning ... required. + Case Management Certification through the Commission for Case Manager Certification (CCMC) or the American Association of Managed Care Nurses… more
- Elevance Health (Miami, FL)
- …state mandated policies, and CMS Coverage Determinations, as applicable. + Perform physician-level case review of utilization requests for procedures and ... necessity decisions. + Brings to their supervisors attention, any case review decisions that require Medical Director...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Molina Healthcare (Orlando, FL)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... unrestricted Certified Clinical Coder + Certified Medical Audit Specialist + Certified Case Manager + Certified Professional Healthcare Management + Certified… more
- MyFlorida (Tallahassee, FL)
- …Protection Division in Tallahassee, Florida. This position functions as office manager for the Tallahassee Consumer Protection bureau, reporting directly to the ... selection process. The Work You Will Do: This position functions as office manager for the Tallahassee Consumer Protection bureau, reporting directly to the Bureau… more
- BayCare Health System (Sarasota, FL)
- …the Emergency Management program for office and agency staff + Participates with Case Manager on initial Plan of Care review with a focus on quality, ... within the area of responsibility + Ensure quality assurance program and utilization review is followed in accordance with Home Care protocol + Oversees and… more
- CenterWell (Jacksonville, FL)
- …performance in patient experience, quality of care, clinical outcomes, and avoidable utilization + Periodically review clinician charts to identify opportunities ... precise + Identify critical issues for high-risk patients during case reviews & other forums, and modeling and driving...of health (SDOH) efforts, improving clinical outcomes and avoidable utilization + Monitor and manage daily patient care and… more
- BayCare Health System (Dunedin, FL)
- …the Emergency Management program for office and agency staff. + Participates with Case Manager on initial Plan of Care review with a focus on quality, ... within the area of responsibility. + Ensure quality assurance program and utilization review is followed in accordance with Home Care protocol. + Oversees and… more
- Elevance Health (Miami, FL)
- …the medical necessity of requests using clinical criteria. + Performs physician-level case review of musculoskeletal utilization requests. + Conducts ... + Extensive orthopedic surgery experience preferred. + Experience with utilization management, especially with CMS guidelines preferred. For candidates working… more
- HCA Healthcare (Kissimmee, FL)
- …patients with discharge planning or psychosocial needs. + Obtains input from the RN case manager to ensure the discharge plan is appropriate and aligns with ... injuries which includes discharge planning and psychosocial needs. + Review of patient notes to help identify psychosocial needs...of level of care, length of stay and resource utilization issues. + Identifying barriers to discharge and contacting… more
- AdventHealth (Orlando, FL)
- …Care Management Supervisor is under the general leadership of the Care Management Manager or Facility Director and assists in monitoring and performing the daily ... for the daily front line operations as assigned by the Care Management Manager or Facility Director. The Care Management Supervisor will serve as the primary… more