- MTC (Graceville, FL)
- …improvement committee. 7. Closely monitor all potential catastrophic events and perform utilization review and tracking. 8. Submit and implement recommendations ... Monitor delivery of mental health care, audit patient records, review and complete monthly statistical reports, analyze, distribute, and...for improvements in services and optimal utilization of staff. 9. Develop and monitor effectiveness of… more
- CenterWell (Daytona Beach, FL)
- …in patient experience, quality of care, clinical outcomes, and avoidable utilization *Periodically review clinician charts to identify opportunities in ... social determinants of health (SDOH) efforts, improving clinical outcomes and avoidable utilization *Monitor and manage daily patient care and initiatives to improve… more
- Molina Healthcare (FL)
- …rate tracking and supplemental data impact reporting. + Develop Medical Record Review project reporting to track progress and team productivity reporting. + ... and other statistical methodologies to predict future trends in cost, utilization , and performance. + Assist with research, development and completion of… more
- Cleveland Clinic (Coral Springs, FL)
- …required, as needed.** A caregiver who excels in this role will: + Review daily assignments and ascertain surgeon-specific preferences and anesthesia. + Identify and ... follow-through. + Demonstrate prudence in par level supplies and utilization . + Serve as a resource individual for a...decreased turnover time per CPT and scheduled procedural time review . + Assure that all instrumentation is returned to… more
- CenterWell (Jacksonville, FL)
- …performance in patient experience, quality of care, clinical outcomes, and avoidable utilization + Periodically review clinician charts to identify opportunities ... of health (SDOH) efforts, improving clinical outcomes and avoidable utilization + Monitor and manage daily patient care and...and monitor clinical & financial performance and metrics. + Review clinician schedules and incentive plans to align with… more
- BayCare Health System (Bradenton, FL)
- …bodies within the area of responsibility. + Ensure quality assurance program and utilization review is followed in accordance with Home Care protocol. + ... + Participates with Case Manager on initial Plan of Care review with a focus on quality, utilization and individual patient care goals. + Knowledge of regulatory… more
- Elevance Health (Tampa, FL)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... appeal case reviews with attending physicians or other ordering providers to discuss review determinations. + Serves as a resource and consultant to other areas of… more
- Elevance Health (Tampa, FL)
- …program, including Prior Authorizations, Medication Therapy Management (MTM), Lock-in, and Drug Utilization Review (DUR) programs. **How you will make an ... the Pharmacy and Therapeutics Committee including therapeutic class reviews, policy review , drug monographs, and formulary recommendations. + Develop strategies to… more
- Molina Healthcare (Tampa, FL)
- …analysts on software applications, business domain and design standards. *Conducts peer review of other analysts (internal and contract staff) to ensure standards ... Years of experience in Analysis related to HEDIS rate tracking, Medical Record Review tracking, Interventions tracking for at least one line of business among… more
- Highmark Health (Tallahassee, FL)
- …designs, competitive position, product development, network options, strategic partnerships, utilization review , local/national client demographics and dentist ... confidentiality agreements. Monitor financial performance of contracts by tracking utilization and competitive environment, including group specific performance guarantees.… more