- CenterWell (Tallahassee, FL)
- …member service or customer service telephone experience desired + Experience with Utilization Review and/or Prior Authorization, preferably within a managed care ... part of our caring community and help us put health first** Utilization Management Administration Coordinator II...senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy… more
- Humana (Tallahassee, FL)
- …+ Previous experience in utilization management, case management, discharge planning and/or home health or rehab + Certification in Case Management (CCM) or ... part of our caring community and help us put health first** The Pre-Authorization Nurse 2 reviews prior authorization...using clinical judgment and refers to internal stakeholders for review depending on case findings. + Educates providers on… more
- CVS Health (Lakeland, FL)
- …your understanding of patient safety and error prevention, quality assurance drug utilization review (DUR), pharmacy professional standards such as corresponding ... culture of continuous improvement, with the goal of changing health care for the better. **Position Summary:** At CVS...an essential pharmacist function + Ability to work in home store, and across the market in other locations,… more
- CVS Health (Tallahassee, FL)
- At CVS Health , we're building a world of health...Medical Director you will + Focus primarily on overseeing utilization review / quality assurance and be ... ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health ...every day. **This is a remote based (work from home ) role preferably resides in Florida and** **must have… more
- CVS Health (Tallahassee, FL)
- …experience in Health Care Delivery System eg, Clinical Practice and Health Care Industry. *Prior UM ( Utilization Management) experience *Active and current ... At CVS Health , we're building a world of health...care resources. This is a remote based (work from home ) role. Preferred candidates will have Internal Medicine or… more
- Humana (Tallahassee, FL)
- …quality management, utilization management, case management, discharge planning and/or home health or post acute services such as inpatient rehabilitation. ... insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review organization,… more
- CenterWell (Tallahassee, FL)
- …largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is ... part of our caring community and help us put health first** The Lead - Medicaid Customer Success oversees...performance and proactively bring issues to the forefront for review + Support new business implementations with a goal… more
- HCA Healthcare (Gainesville, FL)
- …is preferred + BSN is preferred + Certification in Case Management, Nursing or Utilization Review is preferred HCA Florida North Florida Hospital is a 523-bed, ... Florida North Florida Hospital, offers a total rewards package that supports the health , life, career and retirement of our colleagues. The available plans and… more
- ChenMed (Tamarac, FL)
- …and explain primary care provider role. Facilitate patient/family conferences to review treatment goals, optimize resource utilization , provide family education ... acute care, nursing homes, skilled nursing facilities (SNF) and home settings depending on the nature of the assignment....financing, marketing and policy decisions impact the quality of health care. + Applies skills in peer review… more
- Humana (Tallahassee, FL)
- …quality management, utilization management, case management, discharge planning and/or home health or post acute services such as inpatient rehabilitation. ... insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review organization,… more