- Centene Corporation (Tallahassee, FL)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... workplace flexibility. **Florida Residency Required** **Position Purpose:** Performs a clinical review and assesses care related to mental health and substance… more
- CenterWell (Daytona Beach, FL)
- …performance in patient experience, quality of care, clinical outcomes, and avoidable utilization *Periodically review clinician charts to identify ... and operational budgeting, and monitor clinical & financial performance and metrics. * Review clinician schedules and incentive plans to align with patient… more
- CenterWell (Jacksonville, FL)
- …clinical performance in patient experience, quality of care, clinical outcomes, and avoidable utilization + Periodically review clinician charts to identify ... of health (SDOH) efforts, improving clinical outcomes and avoidable utilization + Monitor and manage daily patient care and...and monitor clinical & financial performance and metrics. + Review clinician schedules and incentive plans to… more
- Molina Healthcare (Tampa, FL)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically… more
- Molina Healthcare (St. Petersburg, FL)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... / MCG guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). **MULTI STATE / COMPACT LICENSURE**… more
- Community Based Care of Brevard, Inc. (Orlando, FL)
- …families, group homes, and other specialized providers to ensure appropriate service utilization . The Placement Stabilization Clinician works closely with the ... Salary: $57,000/year Position Summary: The Placement Stabilization Clinician is responsible for ensuring the stability of high-acuity children and youth in licensed… more
- Molina Healthcare (FL)
- **JOB DESCRIPTION** **Job Summary** Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically ... multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. **Required Qualifications** * At least 2… more
- Elevance Health (Miami, FL)
- …diploma or equivalent, and a minimum of 2 years of clinical experience and/or utilization review experience. + Current active, valid and unrestricted LPN/LVN or ... **Medical Management Clinician Associate** **Locations:** Tampa, FL or Miami, FL...Previous clinical experience at a skilled nursing facility or utilization management experience strongly preferred. Please be advised that… more
- Elevance Health (Tampa, FL)
- …or equivalent. + Requires a minimum of 2 years of clinical experience and/or utilization review experience. + Current active, valid and unrestricted LPN/LVN or ... Medical Management Clinician Associate - 40 hours, 4-5 days/week, Saturdays...hrs, 10 hours, or 8 hours. The **Medical Management Clinician Associate** responsible for ensuring appropriate, consistent administration of… more
- Sedgwick (Tallahassee, FL)
- …(10) of related experience required to include one (1) to three (3) years utilization review experience and three (3) years clinical quality control. **Skills & ... criteria; to provide leadership within the dedicated team of clinician and claim professionals in support of the dedicated...+ Knowledge of ADAA and FMLA + Knowledge of utilization review procedures + Knowledge of clinical… more