- Healthfirst (FL)
- … management, identifying alternative care options, and discharge planning** + **Certified Case Manager ** + **Interqual and//or Milliman knowledge** + **Knowledge ... This position is 100% Remote** **Duties//Responsibilities:** + **Provides case management services for assigned member caseloads which includes:** +… more
- Community Based Care of Brevard, Inc. (Orlando, FL)
- Salary: $65,000/year Position Summary: The UM Program Manager provides oversight and management of service authorization data validation, reporting and trend ... provider invoices, reviews line-by-line entries, and submits to finance for payment. The UM Program Manager reconciles ARGOS Dependency Cases to FSFN for… more
- Molina Healthcare (Orlando, FL)
- …medications safety and medication use policies). **KNOWLEDGE/SKILLS/ABILITIES** The Pharmacist, UM will be responsible for reviewing coverage determinations and ... in a timely, compliant, and accurate manner. The Pharmacist, UM will also be responsible for serving as a...changes for the upcoming year. + Works with the Case Management department as part of a member-centered interdisciplinary… more
- HCA Healthcare (Lake City, FL)
- …**Introduction** Do you want to join an organization that invests in you as an RN Case Manager PRN? At HCA Florida Lake City Hospital, you come first. HCA ... a difference. We are looking for a dedicated RN Case Manager PRN like you to be...condition and insurance company request and documents in the UM module. + Performs initial screening of identified patients… more
- ERP International (Macdill AFB, FL)
- …Collegiate Nursing Education (CCNE). **Experience:** Minimum 1 years experience as a RN Case Manager within the past 24 months. Certification:** Possess one of ... for community resources. * Integrate CM and utilization management ( UM ) and integrating nursing case management with...the following certifications: o Commission for Case Manager Certification Certified … more
- University of Miami (Miami, FL)
- …. The Department of Human Genetics is currently seeking a full time Manager , Programs to work in Miami. The Manager , Programs provides direction, ... in the Program Director's absence within prescribed limits of authority. The Manager , Programs will be responsible for overseeing activities and functions of the… more
- Elevance Health (Tampa, FL)
- **JR168679 Behavioral Health Care Manager I** The Behavioral Health Care Manager I is responsible for conducting utilization management reviews for mental health ... necessary quality behavioral healthcare in a cost-effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to Peer Reviewers as… more
- Elevance Health (Miami, FL)
- …nationally recognized criteria (eg, MCG, InterQual, CMS guidelines). + Collaborate with UM nurses and case managers to review inpatient admissions, outpatient ... coverage during **assigned weekend rotations** to support continuity of UM operations and ensure timely case processing....Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- University of Miami (Miami, FL)
- …and water conservations project opportunities new to the University, prepare business case rationale. + Builds, leads, and motivates multiple teams, representing the ... on the creativity and diversity of campus project team members and other UM employees alike. + Supports the business development and management of strategic… more
- Highmark Health (Tallahassee, FL)
- …industry, corporate, state, and federal law standards and are within the care manager 's professional discipline. + For assigned case load, create care plans ... :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides oversight over… more
- Veterans Affairs, Veterans Health Administration (Pensacola, FL)
- …strong leadership, demonstrate expertise in the role of the administrator and program manager , and be comfortable in the role of educator, and direct service ... quality and take appropriate action, such as SAIL, EDRP, UM , Patient Experience, Patient Flow, Infection Prevention, PI Nurse,...(may be extended up to two years on a case -by- case -basis.) NOTE: Grandfathering Provision - All persons… more
- University of Miami (Miami, FL)
- …and quotes have been authorized for use by appropriate party with completed of UM release forms. + Coordinating donor family special projects such as the Gift of ... Rose Parade Donate Life Float and Transplant Games. + Assisting Community Services Manager with soci al media initiatives (Facebook, Twitter) to share Donor Family… more