- Highmark Health (Tallahassee, FL)
- …DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the multidisciplinary team ... Inc. **Job Description :** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in… more
- Evolent (Tallahassee, FL)
- …center staff. Initial clinical reviewers are supported by Physician clinical review staff (MDs) in the utilization management determination process. **What ... Therapy you will be a key member of the utilization management team. We can offer you a meaningful...outcomes. **Collaboration Opportunities: ** + Functions in a clinical review capacity to evaluate all cases, which do not… more
- MyFlorida (Tallahassee, FL)
- …Completes purchasing actions for office supplies as well as purchase orders for Local Review Chairpersons and Utilization Control Physician in the Regional ... Office using the My Florida Marketplace system. Assists Regional Operations Manager in responding in an accurate and timely fashion to all assignments and deadlines. Maintains signature folder for Regional Operations Manager daily. Disburses signed documents… more
- HCA Healthcare (Gainesville, FL)
- …a data-driven environment of quality and cost improvement and develops systems to review utilization of resources and objectively measure outcomes of care in ... for appeals and denials process, discharge planning, case management, and utilization review /management. + Consults with facility-level staff regarding delegated… more
- AdventHealth (Altamonte Springs, FL)
- …CEO, the Chief Medical Officer (CMO) assumes a pivotal role in providing physician leadership and enhancing clinical outcomes. The CMO spearheads efforts to bolster ... liaison between physicians and Case Management staff to optimize resource utilization , ultimately resulting in enhanced patient service, improved medical staff… more
- Centene Corporation (Tallahassee, FL)
- …management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , quality ... physician education with respect to clinical issues and policies. + Identifies utilization review studies and evaluates adverse trends in utilization of… more
- Evolent (Tallahassee, FL)
- …the support services review process. Responsible for the quality of utilization review determinations, including appeals. + Provides input into audit ... requested basis, reviews appeal cases and/or attends hearings for discussion of utilization management decisions. + Strong partnership with Physician Business… more
- Ascension Health (Jacksonville, FL)
- …areas of responsibility, to include but not limited to; + Quality and Safety + Utilization Review + Peer Review and Credentialing + Growth and Strategic ... Ensures adherence and completion of medical staff decisions regarding peer review and physician behavioral issues. + Leads the development of continuing medical… more
- ChenMed (North Miami Beach, FL)
- …assess and record patients' progress and adjust and plan accordingly. + Understanding utilization review and how to leverage with inpatient staff for possible ... experience required. + A minimum of 1 year of utilization review and/or case management, home health,...and changing America's healthcare for the better. Family-owned and physician -led, our unique approach allows us to improve the… more
- Molina Healthcare (FL)
- …and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource ... management. + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure a high quality of patient care,… more