- Humana (Tallahassee, FL)
- …Degree or BSN degree. + Minimum 3 years of experience in NCQA Health Plan Accreditation and/or Utilization Management + Exceptional attention to detail. + ... help us put health first** We are seeking a Senior Accreditation Professional who will work in...on NCQA accreditation standards, especially related to Utilization Management and/or Behavioral Health; MED-Deeming … more
- Humana (Tallahassee, FL)
- …a part of our caring community and help us put health first** The Senior Compliance Nurse reviews utilization management activities and documentation to ... to prevent and detect fraud, waste, and abuse. The Senior Compliance Nurse work assignments involve moderately complex to...action + Minimum two, (2) years of experience in utilization management + Intermediate proficiency using Microsoft… more
- MyFlorida (Chattahoochee, FL)
- SENIOR HUMAN SERVIC COUNSELOR SUPV - SES - 60005161 Date: May 6, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify ... Requisition No: 852115 Agency: Children and Families Working Title: SENIOR HUMAN SERVIC COUNSELOR SUPV - SES - 60005161...knowledgeable of and utilize the principles of Total Quality Management . The employee in this position is responsible for… more
- Raymond James Financial, Inc. (St. Petersburg, FL)
- …organized to deliver project objectives, and comply with the organization's project management framework. + Manage the delivery of research, workshops, and other ... and presenting variances with narrative at appropriate review points to ensure effective utilization . + Assign short-term work schedules to a team of subordinates in… more
- Molina Healthcare (Tampa, FL)
- …continuous quality improvement of the provider database, compliance with regulatory/ accreditation requirements, and Network Management business operations. ... improvement initiatives as it pertains to other provider network management areas. **KNOWLEDGE/SKILLS/ABILITIES** + Bridge communication and collaboration between… more
- Evolent (Tallahassee, FL)
- …selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director. ... , you will be a key member of the utilization management team. We can offer you... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- AdventHealth (Davenport, FL)
- …members of the medical staff on regulatory updates and changes related to CDI,HIM, utilization management and care management . Serves as a community resource ... quality medical care. Drives clinical outcomes for the campus. Works collaboratively with senior management , patient care leaders, and managers as well as staff… more
- Humana (Tallahassee, FL)
- …a part of our caring community and help us put health first** The Senior Utilization Management Behavioral Health Professional utilizes behavioral health ... and communication of medical services and/or benefit administration determinations. The Senior Utilization Management Behavioral Health Professional work… more
- HCA Healthcare (Largo, FL)
- …will assemble regional physician advisory panels to provide ongoing feedback to HCA senior management , and serves as a liaison between committees and ... review/ management + You will consult with facility-level staff regarding delegated utilization management and disease management operations under managed… more
- Evolent (Tallahassee, FL)
- …selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director. ... the mission. Stay for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to… more