- Actalent (Sunrise, FL)
- Job Title: Behavioral Health Utilization Review SpecialistJob Description The Behavioral Health Utilization Review Specialist conducts ... comprehensive utilization management activities for behavioral health plan members. This role includes...LMHC). + Minimum of two years of experience in utilization review /case management. + At least one… more
- Actalent (Sunrise, FL)
- …+ Prepare and present reports on department activities as assigned. Essential Skills + Clinical review + Utilization review + Utilization management + ... or LPN License. + Minimum of one year of utilization review experience and discharge planning in...employee and dependents) * Short and long-term disability * Health Spending Account (HSA) * Transportation benefits * Employee… 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
- Actalent (Sunrise, FL)
- Utilization Management Behavioral Health ClinicianUtilization Management Behavioral Health Clinician We're seeking a dedicated Behavioral ... this role, you'll collaborate with an interdisciplinary team to review and authorize behavioral health ...Conduct utilization reviews and service authorizations for behavioral health and substance use treatments. +… more
- HCA Healthcare (Atlantis, FL)
- …Do you want to join an organization that invests in you as a Utilization Review Services Coordinator? At Parallon, you come first. HCA Healthcare has ... for a low copay. Plans include prescription drug and behavioral health coverage as well as free...make a difference. We are looking for a dedicated Utilization Review Services Coordinator like you to… more
- Monte Nido (Miami, FL)
- …lives while providing the opportunity for people to realize their healthy selves. ** Utilization Review Clinician** **Monte Nido** **Remote - EST or CST hours** ... strategies to provide comprehensive care within an intimate home setting. The Utilization Review **Clinician** is responsible for conducting daily administrative… more
- Elevance Health (Miami, FL)
- **JR153784 Behavioral Health Care Manager II** The Behavioral Health Care Manager II is a utilization management role and is responsible for ... utilization management review for Behavior Analysis services. **Location** : Virtual: This...resources. + Will serve as a resource to other Behavioral Health Care Managers. + Assists with… more
- Elevance Health (Tampa, FL)
- ** Behavioral Health Care Manager II** This role enables associates to work virtually full-time, with the exception of required in-person training sessions, ... work-life integration, and ensures essential face-to-face onboarding and skill development. The ** Behavioral Health Care Manager II** is responsible for managing… more
- Centene Corporation (Tallahassee, FL)
- …including a fresh perspective on workplace flexibility. **Centene is Hiring: Remote Behavioral Health Clinical Liaison (Florida)** **Centene is seeking a ... Behavioral Health Clinical Liaison to join our Sunshine ...the Operations and Medical Management teams. Assesses and performs review of member clinical records and services related to… more
- Molina Healthcare (St. Petersburg, FL)
- …facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need ... Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG… more
- Molina Healthcare (Tampa, FL)
- **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN in United States who has a compact, multi-state license. This team reviews the prior ... transplants; the ideal candidate will have experience either in utilization review or case management for transplants....an integrated delivery of care across the continuum, including behavioral health and long-term care, for members… more
- Veterans Affairs, Veterans Health Administration (West Palm Beach, FL)
- …Manager. Under the clinical and administrative direction of the Assistant Chief, Mental Health & Behavioral Science Service, will oversee many aspects of mental ... health resource utilization , such as use of... health resource utilization , such as use of...VHA Education Loan Repayment Services program office after complete review of the EDRP application. VA offers a comprehensive… more
- CVS Health (Miami, FL)
- …and coordinating care management activities with members to ensure that their medical and behavioral health needs are met and to enhance the member's overall ... + Using advanced clinical skills, performs crisis intervention with members experiencing a behavioral health or medical crisis and refers them to the appropriate… 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)
- …SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health care services, application of ... utilization , identification of opportunities for referral to a Health Coach/case management, and identification and resolution of quality issues. Monitors… 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
- University of Florida (Sumter County, FL)
- …and/or program evaluation tracking, outcome assessment, and quality assurance and service utilization review . + Broad, systems thinking and knowledge of ... and external stakeholders to advance the field. + Conducting Literature Reviews:Regularly review current literature related to aging, cognitive health , and… 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...Health Professional III Lic PRN opening. We promptly review all applications. Highly qualified candidates will be directly… 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