- Molina Healthcare (Orlando, FL)
- **JOB DESCRIPTION** **Job Summary** The Clinical Appeals Nurse (RN) provides support for internal appeals clinical processes - ensuring that appeals requests are ... regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. Assesses appropriateness of services, length of stay and… more
- Centers Plan for Healthy Living (Margate, FL)
- …applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works within a multidisciplinary team to help ... in their home to improve their quality of life. Utilization Management Clinical Reviewer will assess and process all authorization requests to determine medical… more
- Humana (Tallahassee, FL)
- …with other team members. **Achieve your best at Humana. Join Us!** The UM Administration Coordinator provides non- clinical support for the policies and ... Solutions UM Team is hiring for a UM Administration Coordinator 2 that will provide non- clinical...the nursing team + Builds and pends authorizations for review + Responsible for inbound and outbound calls to… more
- Humana (Tallahassee, FL)
- …support assignments. Performs computations. Typically works on semi-routine assignments. The UM Administration Coordinator 2 provides non- clinical support for ... a part of our caring community and help us put health first** The UM Administration Coordinator 2 contributes to administration of utilization management. The UM … more
- Elevance Health (FL)
- …necessary quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to Peer Reviewers ... Health family of companies, **Carelon Behavioral Health** , offers superior clinical mental health and substance use disorder management, a comprehensive employee… more
- Elevance Health (FL)
- …medically necessary quality behavioral healthcare in a cost-effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to Peer ... outpatient professional treatment health benefits through telephonic or written review . The BH Care Manager ( UM ) job...an impact:** + Uses appropriate screening criteria knowledge and clinical judgment to assess member needs to ensure access… more
- Evolent (Tallahassee, FL)
- …work with the Director of UM to ensure client satisfaction. Perform all peer clinical review activities while located in a state or territory of the United ... staff to ensure timely and accurate communication of clinical decisions. Responsible for completion of UM ...of clinical decisions. Responsible for completion of UM projects and participation in site visit reviews. Respect… more
- CenterWell (Tallahassee, FL)
- …this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review ... and work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal… more
- Humana (Tallahassee, FL)
- …this knowledge in their daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, review of ... and work is assisted by diverse resources which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, internal… more
- Humana (Tallahassee, FL)
- …and work is assisted by diverse resources, which may include national clinical guidelines, CMS policies and determinations, clinical reference materials, ... reviewing of all submitted medical records, synthesizing complex hospital-based clinical scenarios, and providing expert decisioning on the requested services.… more
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