- Terracon (Winter Park, FL)
- …operations of a department including staff training, development, and performance review , utilization of equipment and facilities, safety oversight, quality ... + Certified Hazardous Materials Manager (CHMM) + Terracon Authorized Project Reviewer status preferred **General Working Conditions:** + This position requires the… more
- Molina Healthcare (FL)
- …in preparation for national committee for quality assurance (NCQA) and utilization review accreditation commission (URAC) certifications. * Provides leadership ... of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies to ensure… more
- Molina Healthcare (Orlando, FL)
- …on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. JOB DESCRIPTION Job SummaryProvides support for clinical member ... services review assessment processes. Responsible for verifying that services are...to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications *… more
- Molina Healthcare (Tampa, FL)
- JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically ... with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At least 2… more
- ChenMed (Lauderhill, FL)
- …leaders, external clients and HMO to establish, maintain and support outpatient utilization management in PMR and delegated utilization management in ChenMed ... Medical Centers. **Primary Duties and Responsibilities** + Daily review of approved and pended outpatient requests for PMR clients and ChenMed Markets. + Provide… more
- HCA Healthcare (Bradenton, 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
- Molina Healthcare (FL)
- …Summary** Molina's Behavioral Health function provides leadership and guidance for utilization management and case management programs for mental health and chemical ... Health care management programs. **Knowledge/Skills/Abilities** Provides Psychiatric leadership for utilization management and case management programs for mental health… more
- RxBenefits (Jacksonville, FL)
- …channel management, B/G classifications, specialty designations, rebate eligibility, utilization trend, Utilization Management (UM) implications, Manufacturer ... structure, new prospect member size, marketing agreements, broker commissions, and drug utilization . + Be the SME on dozens of medical vendor/PBM contracts including… 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
- TECO Energy (Tampa, FL)
- …short-term resource availability and preparation of the Unit Commitment Plan for review and approval by Grid Operations. This includes topics involving economic ... Fuels department. + Conducts short-term analyses to develop energy resource utilization alternatives and makes recommendations on each alternative. The alternatives… more