- HCA Florida Bayonet Point Hospital (Hudson, FL)
- …services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed ... Florida Bayonet Point Hospital, offers a total rewards package that supports the health , life, career and retirement of our colleagues. The available plans and… more
- Actalent (Sunrise, FL)
- Job Title: Behavioral Health Utilization Review NurseJob Description We are seeking a dedicated Utilization Management Nurse (UMN) who will work ... reports on department activities as assigned. Essential Skills + Utilization management + Behavioral Health ...+ Behavioral Health + Mental Health + Clinical review + Utilization… more
- Actalent (Sunrise, FL)
- Job Title: Behavioral Health Utilization Review NurseJob Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing ... department activities as assigned. Essential Skills + Experience in utilization management, behavioral health , and...mental health . + Proficiency in clinical and utilization review processes. + Current unrestricted Florida… more
- Centene Corporation (Tallahassee, FL)
- …medical appropriateness in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine ... outlined by the applicable state required. Master's degree for behavioral health clinicians required. Clinical knowledge and...health and substance abuse preferred. Knowledge of mental health and substance abuse utilization review… more
- Molina Healthcare (St. Petersburg, FL)
- …dependency services - working closely with regional medical directors to standardize behavioral health utilization management policies and procedures to ... -related regional medical necessity reviews and cross coverage. * Standardizes behavioral health -related utilization management, quality, and financial… more
- Molina Healthcare (Tampa, FL)
- **JOB DESCRIPTION** **Job Summary** Molina's Behavioral Health function provides leadership and guidance for utilization management and case management ... and chemical dependency services and assists with implementing integrated Behavioral Health care management programs. **Knowledge/Skills/Abilities** Provides… more
- Centene Corporation (Tallahassee, FL)
- …management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , quality ... of physician education with respect to clinical issues and policies. + Identifies utilization review studies and evaluates adverse trends in utilization … more
- Molina Healthcare (Orlando, FL)
- …plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. ... Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG… more
- Elevance Health (Miami, FL)
- …clients/ members. The medical director provides clinical expertise in all aspects of utilization review and case management. Provides input on the clinical ... state or territory of the United States when conducting utilization review or an appeals consideration and...For Health Solutions and Carelon organizations (including behavioral health ) only, minimum of 5 years… more
- Elevance Health (Miami, FL)
- …Freedom Health , and Optimum Healthcare Plans and will be responsible for utilization review case management for these markets. May be responsible for ... state or territory of the United States when conducting utilization review or an appeals consideration and...For Health Solutions and Carelon organizations (including behavioral health ) only, minimum of 5 years… more
- CVS Health (FL)
- …other clinical services that are evidence-based. * Work collaboratively with the Behavioral Health , Pharmacy, Member Outreach, Care Management, National Quality ... to improve health outcomes. * Leverage extensive knowledge of health care delivery system, utilization management, reimbursement methods and treatment… more
- ChenMed (Tampa, FL)
- … Health Registry. + LCSWs will manage complex behavioral health patient issues by providing casework, utilization management and discharge planning ... we need great people to join our team. The LCSW/ Behavioral Health Specialist assists, coordinates and manages...maintains daily logs for reporting purposes and for weekly review . + Maintains Communication with Other Healthcare Team Members… more
- HCA Healthcare (Tamarac, FL)
- …services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed ... in developing department goals and clinical programming. + Performs utilization review as assigned. + Helps with...in our Orthopedic and Spine Institute. Our Center for Behavioral Health offers inpatient child, adolescent, adult,… more
- Highmark Health (Tallahassee, FL)
- …**Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides ... oversight over a specified panel of members that range in health status/severity and clinical needs; and assesses health management needs of the assigned member… more
- Elevance Health (FL)
- …law._ The **Medical Director** is responsible for the administration of physical and/or behavioral health medical services, to ensure the appropriate and most ... state or territory of the United States when conducting utilization review or an appeals consideration and..._For Health Solutions and Carelon organizations (including behavioral health ) only, a minimum of 5… more
- HCA Healthcare (West Palm Beach, FL)
- …services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed ... in developing department goals and clinical programming. + Performs utilization review as assigned. + Helps with...a 280-bed acute care facility. We have a 124-bed behavioral health unit. We are located in… more
- Ascension Health (Jacksonville, FL)
- …areas of responsibility, to include but not limited to; + Quality and Safety + Utilization Review + Peer Review and Credentialing + Growth and Strategic ... conduct. Ensures adherence and completion of medical staff decisions regarding peer review and physician behavioral issues. + Leads the development of… more
- Highmark Health (Tallahassee, FL)
- …NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the ... **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most… more
- HCA Healthcare (Gainesville, FL)
- …services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed ... in developing department goals and clinical programming. + Performs utilization review as assigned. + Helps with...growth, we encourage you to apply for our Mental Health Professional III Licensed opening. We promptly review… more
- HCA Healthcare (Gainesville, FL)
- …services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed ... in developing department goals and clinical programming. + Performs utilization review as assigned. + Helps with...Health Professional III Lic PRN opening. We promptly review all applications. Highly qualified candidates will be directly… more
