- 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
- 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
- HCA Healthcare (Tallahassee, FL)
- …+ Assembles regional physician advisory panels to provide ongoing feedback to HCA senior management , and serves as a liaison between committees and ... review/ management . + Consults 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. ... 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 (Orlando, FL)
- …+ Identifies appropriate community agency linkages for student learning experiences + Management of space utilization , strategic planning, Department events, and ... overseeing hiring processes, maintaining program budgets, ensuring compliance with accreditation requirements, and representing the department within the institution.… more
- HCA Healthcare (Port St. Lucie, FL)
- …standards for ACGME simulation requirements. This positions also coordinates the utilization of simulation resources to ensure fidelity of curricula and assessments ... pedagogy to faculty and staff across all programs. + Work closely with senior leadership to prepare supporting documentation as required for ACGME accreditation … more
- Evolent (Tallahassee, FL)
- …Doing:** Job Description As a FMD, Radiology you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
- ChenMed (Miami, FL)
- …organization and future plans. + Provides leadership and direction to the region's senior management team to ensure the organization's strategic plan is ... accountability for development and monitoring of the budget, staff resource utilization , public relations, sales and marketing, program monitoring and related… more
- AdventHealth (Altamonte Springs, FL)
- …and changes. Leads the training and oversight of Critical Incident Stress Management for our system. Helps local ministry leaders integrate models of spiritual ... procedures necessary to achieve objectives for the system to ensure maximum utilization and stability of personnel; | Plans and develops system-wide Ministry… more
- Evolent (Tallahassee, FL)
- …members and providers + Appropriately identifies and refers quality issues to the Senior Director of Medical Management or Medical Director. + Appropriately ... policies + Creates adverse determination notifications that meet all accreditation , State, and Federal criteria + Uses Plain Language...identifies potential cases for Care Management programs + Communicates appropriate information to other staff… more
- University of Miami (Miami, FL)
- …the efficient and timely scheduling of patients for clinics. Moreover, the Senior Practice Manager (H) develops, trains, coordinates, and recruits personnel for the ... Myeloma NST fellowship, including scheduling, documentation, ensuring compliance with accreditation standards. + Coordinate quarterly meetings with patient access… more