- AdventHealth (Tampa, FL)
- …for escalation to the Physician Advisor or designated leader for additional review as determined by department standards. The Utilization Management Nurse ... Loan Repayment Program Career Development Whole Person Wellbeing Resources Mental Health Resources and Support **Our promise to you:** Joining AdventHealth is… more
- CenterWell (Tallahassee, FL)
- …Experience a plus + Current nursing experience in Hospital, SNF, LTAC, DME or Home Health . + Bilingual We offer tangible and intangible benefits such as ... medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part...senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy… more
- BAYADA Home Health Care (Jacksonville, FL)
- …ready to lead with purpose in a dynamic and growing healthcare field? **Baptist Home Health Care by BAYADA** is seeking an experienced and compassionate ... **Director** to manage operations at our **Jacksonville, FL Medicare-certified Home Health office** . The ideal candidate will have a strong background in… more
- CenterWell (Clearwater, FL)
- …available patient information related to the case, including disciplines required, to determine home health or hospice needs. Accountable to ensure patients meet ... clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the...transportation. + Two years as a Registered Nurse in home health or hospice, with at least… more
- Actalent (Sunrise, FL)
- …+ Prepare and present reports on department activities as assigned. Essential Skills + Clinical review + Utilization review + Utilization management + ... of resources such as durable medical equipment, hospitalizations, and home healthcare. + Provide current and timely documentation reflecting...or LPN License. + Minimum of one year of utilization review experience and discharge planning in… more
- BayCare Health System (Lakeland, FL)
- …the area of responsibility. + Ensure quality assurance program and utilization review is followed in accordance with Home Care protocol. + Oversees and ... of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers and thousands...Participates with Case Manager on initial Plan of Care review with a focus on quality, utilization … more
- Actalent (Orlando, FL)
- …of cases. Essential Skills + Experience in utilization management, concurrent review , prior authorization, utilization review , case management, and ... Compact RN License, Compact LPN is okay too + Utilization Management/Concurrent Review experience. + ICU/ER experience....skills. Work Environment + This is a full remote work-from- home position. The hours are Monday through Friday from… more
- CVS Health (Tallahassee, FL)
- At CVS Health , we're building a world of health ...lower levels of care - 1+ years' experience in Utilization Review - CCM and/or other URAC recognized ... ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health ...day. **Position Summary** **This is a remote work from home role anywhere in the US with virtual training.**… more
- Evolent (Tallahassee, FL)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director.… more
- CVS Health (Tallahassee, FL)
- …to improve health outcomes. * Leverage extensive knowledge of health care delivery system, utilization management, reimbursement methods and treatment ... and the delivery of cost-efficient care. Will also interact with the members, health systems, nursing facilities, as well as home and community-based networks.… more