- Actalent (Orlando, FL)
- …systems + Work with providers to approve or recommend determinations based on review findings + Educate providers on utilization processes to ensure high-quality ... Clinical Review Nurse - Concurrent Review Location:...preferred) + Knowledge of Medicaid or Medicare regulations and utilization management processes + Proficiency in Microsoft Word, Excel,… more
- Molina Healthcare (FL)
- …or emergency room. Preferred Experience Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of ... JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically… more
- Centene Corporation (Tallahassee, FL)
- …discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in ... health management systems according to utilization management policies and guidelines + Works with healthcare...or provide recommendations based on requested services and concurrent review findings + Assists with providing education to providers… more
- Elevance Health (Miami, FL)
- **Genetic Counselor Review Associate** **Genetic Testing Utilization Review ** **Carelon Medical Benefits Management** **Virtual** : This role enables ... domains, including radiology, cardiology and oncology._ The **Genetic Counselor Review Associate** is responsible for authorization requests and determining their… more
- UL, LLC (Tampa, FL)
- …"approval" of the installation. The evaluation process consists of documentation review , visual and mechanical inspection, suitability for installation in accordance ... new, or modified products in the field + Experienced with the utilization of Electrical Test Equipment. Experienced with conducting electrical tests on products.… more
- Evolent (Tallahassee, FL)
- …focus on **value-based strategy and transformation** . Unlike traditional medical review roles that emphasize volume throughput, this position integrates ... utilization management with collaborative engagement and innovation. **Core Responsibilities**...with collaborative engagement and innovation. **Core Responsibilities** + **Clinical Review & Peer Collaboration** + Serve as the physician… 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
- Terracon (Sarasota, FL)
- …operations of a department including staff training, development, and performance review , utilization of equipment and facilities, safety oversight, quality ... or licensure in field of expertise. + Terracon Authorized Project Reviewer status preferred. **Exemption:** Exempt **Requisition ID:** 34379BR **Posting Title:**… more
- Terracon (West Palm Beach, FL)
- …operations of a department including staff training, development, and performance review , utilization of equipment and facilities, safety oversight, quality ... or licensure in field of expertise. + Terracon Authorized Project Reviewer status preferred. **Exemption:** Exempt **Requisition ID:** 34349BR **Posting Title:**… more
- L3Harris (Palm Bay, FL)
- …analyses and integration activities tailorable for each mission area and program + Review program SV level power engineering work products for consistency + Support ... major technical reviews and failure investigations as an Independent Reviewer + Mentor and train program SV level Power...Vehicle power performance analysis such as processor and memory utilization , data sizing and flows, etc. + Integrated Space… more