- 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
- Elevance Health (Miami, FL)
- …or equivalent. Requires a minimum of 4 years of clinical experience and/or utilization review experience. Current active, valid and unrestricted LPN/LVN license ... Med Management Clinician Senior- Licensed Nurse **Location:** Miami, FL **Hybrid...initiatives to improve the efficiency and effectiveness of the utilization reviews within the medical management processes. + Assesses… more
- Molina Healthcare (FL)
- …or emergency room. Preferred Experience Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of ... JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically… more
- Highmark Health (Tallahassee, FL)
- …of the claim rejection and the proper action to complete the retrospective claim review with the goal of proper and timely payment to provider and member ... Payment Integrity strategies on a pre-payment and retrospective claims review basis. Review process includes a ...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
- Molina Healthcare (Orlando, FL)
- …on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. JOB DESCRIPTION Job SummaryProvides support for clinical member ... services review assessment processes. Responsible for verifying that services are...to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications *… more
- Elevance Health (Tampa, FL)
- …or equivalent. Requires a minimum of 4 years of clinical experience and/or utilization review experience. Current active, valid and unrestricted LPN/LVN license ... **Medical Management Clinician ** - Licensed Nurse **Locations:** Tampa, FL **Hybrid...Friday, 8:00AM - 5:00PM Eastern Time The **Medical Management Clinician ** is responsible for ensuring appropriate, consistent administration of… more
- Actalent (Deland, FL)
- …hospital inpatient and/or ED discharge records, diagnostic and laboratory results for clinician review and treatment follow-up as needed. Essential Skills + ... perform quality team-based patient care under the direct supervision of a clinician . This includes both clinical and administrative functions to promote health and… more
- 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 ... required by law. The **Plan Performance Medical Director** serves as a lead clinician and oversees the administration of medical services for the individual ACA… 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 ... (Saturday and Sunday). The **Medical Management Nurse** will be responsible for review of the most complex or challenging cases that require nursing judgment,… more