- Molina Healthcare (FL)
- …, Healthcare Administration, etc. **PREFERRED EXPERIENCE:** + Peer Review , medical policy/procedure development, provider contracting experience. + Experience ... and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource… 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 ... **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes...Radiology you will be a key member of the utilization management team. We can offer you a meaningful… 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 ... **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes...Oncology, you will be a key member of the utilization management team. We can offer you a meaningful… 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
- CVS Health (Tallahassee, FL)
- …(CHF), Chronic Kidney Disease (CKD), post-acute care, hospice, palliative care, cardiac, home health with Medicare members **Preferred Qualifications** + 4+ ... At CVS Health , we're building a world of health...who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current… more
- HCA Healthcare (Gainesville, FL)
- …guidelines. Participates in developing department goals and clinical programming. + Performs utilization review as assigned. + Helps with Process and Quality ... satisfaction and personal growth, we encourage you to apply for our Mental Health Professional III Licensed opening. We promptly review all applications. Highly… more
- HCA Healthcare (Gainesville, FL)
- …guidelines. Participates in developing department goals and clinical programming. + Performs utilization review as assigned. + Helps with Process and Quality ... for our Mental Health Professional III Lic PRN opening. We promptly review all applications. Highly qualified candidates will be directly contacted by a member… more
- HCA Healthcare (Orange Park, FL)
- …representatives, and other parties as appropriate regarding behavioral services . Performs utilization review as assigned . Participates in developing department ... satisfaction and personal growth, we encourage you to apply for our Mental Health Professional Licensed LCSW opening. We promptly review all applications. Highly… more
- BrightSpring Health Services (Gainesville, FL)
- …report any discrepancies to BM. + Run monthly End of Month reports. + Run and review Utilization - Work all over utilized clients to prevent SVPs. + Time Detail ... living, adult host homes for adults regardless of disability, behavioral/mental health support, in- home pharmacy solutions, telecare and remote support,… more
- HCA Healthcare (Fort Walton Beach, FL)
- …guidelines. Participates in developing department goals and clinical programming. + Performs utilization review as assigned. + Helps with Process and Quality ... an organization that invests in you as a Mental Health Prof III Lic PRN? At HCA Florida Fort...protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care… more