- Humana (Tallahassee, FL)
- …to medical directors and leadership during Medicare and Medicaid LOB - Medicare Clinical Criteria Review (MCCR), Utilization Management Committee (UMC), ... **Desired Qualifications** + Master's degree in health-or business-related field + Utilization management experience (Commercial and/or Medicare ) + Proven… more
- Molina Healthcare (Miami, FL)
- **Job Summary** **_For this position we are seeking a (RN) Registered Nurse who must be licensed for the state of KENTUCKY or have a compact license._** Provides ... achieve operational goals and executes tasks and projects to ensure Centers for Medicare & Medicaid Services (CMS) and State regulatory requirements are met for… more
- CenterWell (Deland, FL)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... delivery, and documentation requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking for performance … more
- Molina Healthcare (St. Petersburg, FL)
- …role must complete courses required to obtain licensure in all states. + Utilization Review Lead responsibilities also include but not limited to, collaborate ... HCS Department staff workload for adherence to the Policies, Procedures, Guidelines, Medicare Model of Care, and deadlines. Assures oversight and direction of… more
- University of Miami (Miami, FL)
- …staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . APP, ... supervises advance d practice providers (APPs) ( ie, Advanced Registered Nurse Practitioners, Physician Assistants etc.). Key responsibilities of this position… more
- Humana (Hallandale Beach, FL)
- …and psycho-social health issues. + Monitor and maintain awareness of utilization and conducts outreach based on acuity to assess medical/social/BH needs ... work or behavioral health-related field + Active licensed Registered Nurse , RN in the state of Florida without disciplinary...protection. Please be aware that applicants selected for leader review may be asked to provide their social security… more