- 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 ... line-by-line entries, and submits to finance for payment. The UM Program Manager reconciles ARGOS Dependency Cases...application for daily entry of case activity and the utilization management of service authorizations. Educational and… more
- Molina Healthcare (Jacksonville, FL)
- …and quality initiatives under the direction of leadership. * Monitors drug utilization and assists leadership team in understanding quality and cost-control issues ... pharmacy benefit changes for the upcoming year. * Works with the care management department as part of a member-centered interdisciplinary care team (ICT). * Works… more
- Centers Plan for Healthy Living (Margate, FL)
- …with the guidance and plans they need for healthy living. JOB SUMMARY: The Utilization Management Care Coordinator works within a multidisciplinary care team to ... the care of members enrolled in our Managed Long Term Care program and facilitate authorization requests for eligible members. PRIMARY RESPONSIBILITIES: + Assists… more
- AdventHealth (Daytona Beach, FL)
- …MEDICAL PKWY, Daytona Beach, 32117 **The role you'll contribute:** The role of the Utilization Management ( UM ) Registered Nurse (RN) is to use clinical ... Days Off from Day One + Student Loan Repayment Program * (For eligible positions) + Career Development + Whole...including concurrent payer communications to resolve status disputes. The Utilization Management Nurse is accountable for a… more
- AdventHealth (Tampa, FL)
- …other diseases. **The ro** **le you'll contribute:** The role of the Emergency Department Utilization Management ( UM ) Registered Nurse (RN) is to use ... Paid Days Off from Day One Student Loan Repayment Program Career Development Whole Person Wellbeing Resources Mental Health...for additional review as determined by department standards. The Utilization Management Nurse is accountable for a… more
- CVS Health (FL)
- …Evaluates, designs, and implements new regulatory and/or business initiatives for Utilization Management from initiation through completion. + Partners ... United States* **Position Summary** The Sr. Manager of the UM Centers of Excellence (COE) is a contributor to...and health plan operations and value creation methodologies including Utilization and Policy Management , Care Management… more
- Veterans Affairs, Veterans Health Administration (Tampa, FL)
- …planning, designing, integrating, implementing, modifying, and administering, a comprehensive quality management program area. The QM/ UM Consultant ... Care System is seeking an experienced, dynamic and talented Registered Nurse for Quality/ Utilization Management . Our ideal applicants are those who want to… more
- University of Miami (Miami, FL)
- …processes including financial/budget matters, utilities systems, condition-based maintenance, work management information technology, water program management ... goals and objectives, and provides resource programming, budgeting and resource allocation, program management and training. + Oversees all utility use and… more
- Molina Healthcare (Orlando, FL)
- …utilization and effective resource management . + Develops and implements a Utilization Management program and action plan, which includes strategies ... adjustment, disease management , and evidence-based guidelines. + Experience in Utilization /Quality Program management + HMO/Managed care experience… more
- AdventHealth (Orlando, FL)
- …Utilization Management . Serves as an active participating member of the Utilization Management ( UM ) Committee by ensuring committee is actively ... this role educates, informs, and advises members of the Utilization Management , Health Information Management ...succeed** **:** + Graduate from medical school and residency program + 5 Recent clinical practice Required + MD… more
- Elevance Health (Miami, FL)
- …to members and providers. + Provides guidance for clinical operational aspects of a program . + Perform utilization management reviews to determine medical ... State agency. **Preferred Qualifications:** + Bilingual- Spanish speaking preferred. + Utilization Management case review experience strongly preferred. +… more
- Elevance Health (FL)
- …+ **Cost of Care / Payment Integrity** + **Care Management / Utilization Management (CM/ UM ) Modernization** + **Provider Networking & Modernization** + ... managed care, or healthcare leadership preferred. + Experience advising medical cost management , utilization management , payment integrity, or provider… more
- CVS Health (FL)
- …outcomes. * Leverage extensive knowledge of health care delivery system, utilization management , reimbursement methods and treatment protocols for DSNP/MMP ... Behavioral Health, Pharmacy, Member Outreach, Care Management , National Quality Management , Utilization Management , Compliance, and other departments to… more
- AdventHealth (Orlando, FL)
- …and serves as a resource to Medical Staff colleagues regarding best practices, Utilization Management and Care Management structures, and functions and ... Days Off from Day One + Student Loan Repayment Program + Career Development + Whole Person Wellbeing Resources...productive internal/external relationships with all physicians and constituents of Utilization Management , Care Management and… more
- University of Miami (Miami, FL)
- …program 's overall success. + Serves as a liaison between the Program Director(s), administrative leadership, UM /JMH Graduate Medical Education (GME) ... + Required to learn and become competent in the utilization of new software. + Performs other duties as...a relevant field + New Innovations online software Residency Management System + ACGME Program requirements #LI-GD1… more
- HCA Healthcare (Lake City, FL)
- …a part of our team. **Job Summary and Qualifications** Provides hospital case management / utilization review and discharge planning to assure that the patient ... Degree + One year experience in case management and/or supervisory / management position involving case management / utilization review/responsibility in an… more
- Molina Healthcare (Tampa, FL)
- …experience as a Medical Director in clinical practice * 3 years' experience in Utilization /Quality Program Management * 2+ years HMO/Managed Care experience ... **Job Summary** Molina's Behavioral Health function provides leadership and guidance for utilization management and case management programs for mental… more
- University of Miami (Miami, FL)
- …The department of Medicine has an exciting opportunity for a full-time Sr. Clinical Program Coordinator to work onsite on the UHealth campus. The Sr. Clinical ... Program Coordinator (H) acts as a lead in the...assignment of tasks to internal teams to include schedule management . + Assists with budget preparation and tracks all… more
- Molina Healthcare (Tampa, FL)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management ( UM ) policies and procedures. **Required Qualifications** ... Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual… more
- ERP International (Macdill AFB, FL)
- …algorithms, CM software, and databases for community resources. * Integrate CM and utilization management ( UM ) and integrating nursing case management ... not limited to the following; * Participate in all phases of the Case Management Program (CMP) and ensure that the CMP meets established case management (CM)… more