- Elevance Health (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 ... clinical reviews with attending physicians or other providers to discuss review determinations, and patients' office visits with providers and external physicians.… more
- Veterans Affairs, Veterans Health Administration (Winter Park, FL)
- …of high quality, timely care to the Veteran receiving community services. The CC Case Manager will work collaboratively within the Office of Integrated Veteran ... intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation requirements,… more
- Elevance Health (Tampa, FL)
- …or case management experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or any combination of education and ... and will include weekends. The **Medical Management Nurse** will be responsible for review of the most complex or challenging cases that require nursing judgment,… more
- Prime Therapeutics (Tallahassee, FL)
- …clinical experience. + Experience in managed care, specialty drugs, care management and utilization review . + Meets Credentialing criteria. + At minimum must ... for drug services. + Will actively maintain a required case load and the activities to reach overall goals...Quality oversight for this program is provided by the Manager , Patient Programs. **Education & Experience** + Associates -… more
- BayCare Health System (Lakeland, 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
- CenterWell (Daytona Beach, FL)
- …in patient experience, quality of care, clinical outcomes, and avoidable utilization *Periodically review clinician charts to identify opportunities in ... coaching initiatives are precise *Identify critical issues for high-risk patients during case reviews & other forums, and modeling and driving clinical excellence… more
- AdventHealth (Riverview, FL)
- …orthopedic and womens care. **The role you'll contribute:** The RN Care Manager in collaboration with the patient/family, social workers, nurses, physicians and the ... and progression through the continuum of care. The RN Care Manager ensures efficient and cost-effective care through appropriate resources monitoring, and… more
- AdventHealth (Port Charlotte, FL)
- …in Charlotte County. **The role you'll contribute** **:** The RN Care Manager in collaboration with the patient/family, social workers, nurses, physicians and the ... and progression through the continuum of care. The RN Care Manager ensures efficient and cost-effective care through appropriate resources monitoring, and… more
- AdventHealth (Altamonte Springs, FL)
- …medical staff members and lower cost. Direct reports include + Med Staff Manager PRINCIPAL DUTIES AND JOB RESPONSIBILITIES: + Leads in the continuing adoption of ... as a clinical leader to the hospital's medical staff providing guidance in case management, appropriate levels of care for patients, efficient utilization of… more