- 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 ... patient-specific, safe and timely discharge plan. + Performing verification of utilization criteria reviews. + Building relationships and coordinating with payor… more
- Veterans Affairs, Veterans Health Administration (Miami, FL)
- …primary care and specialty care Is aware and accountable to the fiscal measures and utilization review Pay: Based on approved pay rates per task or service. Fee ... systems of health care by participating in programs, following policies, improving utilization of resources and suggesting process changes for clinical programs in… more
- HCA Healthcare (Kissimmee, FL)
- …while supporting a balance of optimal care and appropriate resource utilization . Identify potential barriers to patient throughput and quality outcomes and ... processes, for the appropriate level of care, patient status, and resource utilization . + Conducts interdisciplinary team meetings to provide a mechanism for all… more
- HCA Healthcare (Gainesville, FL)
- …and/or cellular therapy is required. + Certification in case management, nursing, or utilization review desired. + Bachelors degree required. HCA Florida North ... activities that promote quality outcomes, efficient patient throughput, and optimal resource utilization . **What you will do in this role:** + Coordinate 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 ... patient-specific, safe and timely discharge plan. + Performing verification of utilization criteria reviews. + Building relationships and coordinating with payor… more
- ChenMed (Clearwater, FL)
- …COE and HCT leaders to support improved medical costs and specialty care utilization . This individual will work closely with and consider feedback from those leaders ... COE and HCT leaders to support improved medical costs and specialty care utilization . This individual will work closely with and consider feedback from those leaders… 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
- CVS Health (Tallahassee, FL)
- …outcomes. * Leverage extensive knowledge of health care delivery system, utilization management, reimbursement methods and treatment protocols for DSNP/MMP and other ... Health, Pharmacy, Member Outreach, Care Management, National Quality Management, Utilization Management, Compliance, and other departments to integrate social,… more
- Oracle (Tallahassee, FL)
- …stays. + Knowledge of third-party payor rules and regulations. + 2-3 years of Utilization Review experience in a healthcare setting preferred; 1-2 years of ... college and AHIMA Certified RHIT credentials preferred + Certification in Utilization Review , case management, and healthcare quality preferred… more
- World Insurance Associates, LLC. (Miami, FL)
- … review analysis + Renewal rate and funding initial projections/modeling + Claims utilization review + Rate and contribution modeling + Benchmarking studies + ... self-funded arrangements. You'll prepare financial deliverables, model renewals, evaluate utilization trends, and support client decision-making with data-driven insights.… more