- CenterWell (Lake City, FL)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR. + Valid driver's… more
- Community Health Systems (Naples, FL)
- …for the planning, coordination, and oversight of care management services, including utilization review , discharge planning, and transitions of care. The role ... efficiently, effectively, and in compliance with organizational standards. + Oversees utilization review and discharge planning processes to ensure… more
- Elevance Health (Miami, FL)
- …members and providers. **How you will make an impact:** + Perform physician-level case review , following initial nurse review , of Medical Oncology regimens ... and supportive care. + Perform physician-level case review , following initial nurse review ,...maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care. + Participate… more
- HCA Healthcare (Tallahassee, FL)
- …position if current and compliant** + **Certification in Case Management, Nursing, or Utilization Review , preferred** + **Three years of nursing experience in ... throughput while supporting a balance of optimal care and appropriate resource utilization . The RN CM Care Coordinator will identify potential barriers to patient… more
- HCA Healthcare (Tallahassee, FL)
- …position if current and compliant** + **Certification in Case Management, Nursing, or Utilization Review , preferred** + **Three years of nursing experience in ... throughput while supporting a balance of optimal care and appropriate resource utilization . The RN CM Care Coordinator will identify potential barriers to patient… more
- Select Medical (Lake Worth, FL)
- …and professional growth of the department, including, but not limited to: Utilization Review (UR) and resource management, discharge planning, treatment plan ... of Case Management** **$10,000 Sign On Bonus** **_Clinical license as a registered nurse or respiratory therapist or master's in social work and minimum three (3)… more
- Select Medical (Gainesville, FL)
- …and professional growth of the department, including, but not limited to: Utilization Review (UR) and resource management, discharge planning, treatment plan ... On Bonus** **Full Time: Monday - Friday 8-5pm** **_Clinical license as a registered nurse or respiratory therapist or master's in social work and minimum three (3)… more
- Highmark Health (Tallahassee, FL)
- …of the claim rejection and the proper action to complete the retrospective claim review with the goal of proper and timely payment to provider and member ... Payment Integrity strategies on a pre-payment and retrospective claims review basis. Review process includes a ...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
- Elevance Health (Miami, FL)
- …or equivalent. Requires a minimum of 4 years of clinical experience and/or utilization review experience. Current active, valid and unrestricted LPN/LVN license ... Med Management Clinician Senior- Licensed Nurse **Location:** Miami, FL **Hybrid 1** : This...initiatives to improve the efficiency and effectiveness of the utilization reviews within the medical management processes. + Assesses… more
- BayCare Health System (Sarasota, FL)
- …bodies within the area of responsibility. + Ensure quality assurance program and utilization review is followed in accordance with Home Care protocol. + ... Participates with Case Manager on initial Plan of Care review with a focus on quality, utilization ...regulatory standards appropriate to position **Requirements:** + RN (Registered Nurse ) License + Driver's License, State of Florida required… more