- MyFlorida (Orlando, FL)
- …eligibility and makes recommendations for licensure to supervisor/regional program manager . + Investigates complaints on licensed providers and illegal child ... + Attains a high proficiency/skill level as demonstrated through the competent utilization of the program's hardware, software, system applications and web pages. +… more
- Elevance Health (Tampa, FL)
- …the medical necessity of requests using clinical criteria. + Performs physician-level case review of musculoskeletal utilization requests. + Conducts ... preferred. + Extensive spine surgery experience preferred. + Experience with utilization management, especially with CMS guidelines preferred. + **Orthopedic Spine… more
- CVS Health (Tallahassee, FL)
- …This position reports to the Potential Quality of Care (PQOC) nurse investigator team manager . This position is responsible for the review and evaluation of ... Qualifications** - Emergency/critical care experience - Experience working Grievance cases - Case Management or Utilization Management experience - Managed care… more
- Elevance Health (Miami, FL)
- …policies when making medical necessity decisions. + Brings to their supervisors attention, any case review decisions that require Medical Director review or ... Director** **Carelon Medical Benefits Management** **Post Acute Care Benefit Utilization Management** **Schedule: 10:00-7:00 Central Time** **** **Virtual:** This… more
- Elevance Health (Miami, 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 ... ensuring clinical integrity of broad and significant clinical programs. May perform clinical review . **How you will make an impact:** + May provide clinical guidance… more
- University of Miami (Miami, FL)
- …or staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . CORE JOB ... SUMMARY The Leave and Accommodations Coordinator reports to the Manager , Employee Leave and Accommodations and uses their expertise in administering leave requests… more
- Deloitte (Jacksonville, FL)
- …as general health and group benefits skills. Key Responsibilities + Lead project manager for specific projects or key workstream lead on larger projects. + Evaluate ... Pharmacy Benefit Manager (PBM) contracts, deal terms, and financial proposals. +...vendor selection, negotiation, and implementation. + Assist in the review and negotiation of premium rate/administrative fee renewals. +… more
- ChenMed (Plantation, FL)
- …and explain nurse practitioner role. + Facilitates patient/family conferences to review treatment goals, optimize resource utilization , provide family education ... of the nursing plan of care, health education, physician referrals, case management referrals, follow-up and clear documentation according to ChenMed standards… more
- AdventHealth (Orange City, FL)
- …key hospital departments including surgery, rehabilitation and occupational therapy, nursing, case management, marketing, home health and others involved in the care ... of the patient. Regularly collects data through chart review and computer generated reports. Presents data and reports to Orthopedic Governance Committee and other… more
- MyFlorida (Bradenton, FL)
- …administration, special procedures, etc. according to state and local guidelines; acts as case manager for students with special acute and chronic conditions, ... of their job duties. Knowledge, skills, and abilities, including utilization of equipment, required for the position: + Knowledge...in a culturally sensitive, respectful manner. + Ability to review data for accuracy and completeness. + Ability to… more