- CVS Health (Tallahassee, FL)
- …clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable ... and external constituents in the coordination and administration of the utilization /benefit management function. **Required Qualifications** + 3+ years post… more
- Centene Corporation (Tallahassee, FL)
- …28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive ... accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine overall health of member, treatment… more
- Community Based Care of Brevard, Inc. (Orlando, FL)
- …providers to ensure appropriate service utilization . The Placement Stabilization Clinician works closely with the Behavioral Health Unit to coordinate ... partner with various stakeholders and agency staff and train community stakeholders. Utilization and Fiscal Management : This is preferred to effectively evaluate… more
- Molina Healthcare (Tampa, FL)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... / MCG guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). **MULTI STATE / COMPACT… more
- CenterWell (Jacksonville, FL)
- …performance in patient experience, quality of care, clinical outcomes, and avoidable utilization + Periodically review clinician charts to identify opportunities ... our primary care team, combining clinical practice with leadership and operational management to ensure high-quality patient care and alignment with Value-Based Care… more
- CenterWell (Daytona Beach, FL)
- …in patient experience, quality of care, clinical outcomes, and avoidable utilization *Periodically review clinician charts to identify opportunities in ... our primary care team, combining clinical practice with leadership and operational management to ensure high-quality patient care and alignment with Value-Based Care… more
- CVS Health (Miami, FL)
- …+ Collaborating with multidisciplinary teams such as nutritionist, pharmacist, behavioral clinician , health educators, doctors, providers, wellbeing service ... analyzing and presenting health assessment data, organizational assessment, claim utilization data, employee survey data, biometric screenings data, wellness… more