- HCA Healthcare (Sanford, FL)
- …is preferred + BSN is preferred + Certification in Case Management, Nursing or Utilization Review is preferred HCA Florida Lake Monroe Hospital is a 221-bed ... protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage,… more
- HCA Healthcare (Brooksville, FL)
- …Healthcare Quality) OR CHCQM (Diploma in American Board of Quality Assurance and Utilization Review Physicians). _Individuals without CPHQ or_ CHCQM _will be ... protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage,… more
- CVS Health (Orlando, FL)
- …Social Worker (LCSW) **Preferred Qualifications** + Bilingual Spanish + Managed care/ utilization review experience + Case management and discharge planning ... **Position Summary** : The Clinical Case Manager, Behavioral Health is a work from home field based role with up to 40% travel within Orange, Osceola, Seminole and… more
- Evolent (Tallahassee, FL)
- …Be Doing:** As a Clinical Reviewer, Nurse, you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in ... You Will Be Doing:** + Functions in a clinical review capacity to evaluate all cases, which do not...are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts and analyzes… more
- Molina Healthcare (Tampa, FL)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + Identifies and… more
- AdventHealth (Orlando, FL)
- …to nurses, physicians and the interdisciplinary team on issues related to utilization of resources, medical necessity, CMS CoP for Discharge Planning and care ... the patient including, but not limited to the following: Home Health, Infusion Services, Durable Medical Equipment, Palliative Care,...(as permitted by the patient) as well as a review of the current and past inpatient and outpatient… more
- Ascension Health (Jacksonville, FL)
- …recent work experience in a hospital setting, preferably with some Physician Advisory/ Utilization Management work experience. If you are ready to join a talented ... group of physicians apply today! **Responsibilities** : + Review medical records of identified patients to assist with the level of care and length of stay… more
- ChenMed (Tamarac, FL)
- …and explain primary care provider role. Facilitate patient/family conferences to review treatment goals, optimize resource utilization , provide family education ... occasionally in acute care, nursing homes, skilled nursing facilities (SNF) and home settings depending on the nature of the assignment. The responsibilities include… more
- Humana (Tallahassee, FL)
- …with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health ... health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review … more
- Humana (Tallahassee, FL)
- …with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health ... health insurance, other healthcare providers, clinical group practice management + Utilization management experience in a medical management review organization,… more