- Centene Corporation (Tallahassee, FL)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... appropriateness in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine overall… more
- Monte Nido (Miami, FL)
- …lives while providing the opportunity for people to realize their healthy selves. ** Utilization Review Clinician ** **Monte Nido** **Remote** **Monte Nido has ... within an intimate home setting. We are seeking a Utilization Review Clinician to join...care to individuals with an eating disorder preferred. + Licensed behavioral health clinician /provider, RD, or RN… more
- Centene Corporation (Tallahassee, FL)
- …assess ABA Treatment Plans required. Knowledge of ABA services and BH utilization review process required. Experience working with providers and healthcare ... state (BCBA) required. Master's degree for behavioral health clinicians preferred. Behavioral health clinical knowledge and ability to review and/or… 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 ... degree in a healthcare field, such as social work or clinical counselor (for Behavioral Health Care Review Clinicians only). **Required Experience** 1-3 years of… more
- Molina Healthcare (Orlando, FL)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS… 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