- Humana (Tallahassee, FL)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... action. + Minimum one, (1) year of experience in Behavioral Health Nursing (inpatient outpatient, psych, substance...Nursing experience + Previous experience in utilization management with ASAM knowledge + Health Plan… more
- Humana (Tallahassee, FL)
- …Expertise on NCQA accreditation standards, especially related to Utilization Management and/or Behavioral Health ; MED-Deeming accreditation standards ... degree. + Minimum 3 years of experience in NCQA Health Plan Accreditation and/or Utilization Management...knowledge is a plus. + Registered Nurse or Behavioral Health Licensed Professional. + Managed care,… more
- Humana (Tallahassee, FL)
- …part of our caring community and help us put health first** The Senior Utilization Management Behavioral Health Professional utilizes behavioral ... and communication of medical services and/or benefit administration determinations. The Senior Utilization Management Behavioral Health Professional work… more
- Centene Corporation (Tallahassee, FL)
- …in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine overall health of ... licensure as outlined by the applicable state required. Master's degree for behavioral health clinicians required. Clinical knowledge and ability to review… more
- Evolent (Tallahassee, FL)
- …the mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management ** at Evolent will serve as a point of contact for ... and client contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager, … more
- Molina Healthcare (Jacksonville, FL)
- …state they reside. We are looking for a RN Manager to manage a utilization management team supporting 14 Marketplace plans. Home office with internet ... cover any weekend time if needed Preferred candidate with Utilization Management and leadership experience (Direct Reports)...an integrated delivery of care across the continuum, including behavioral health and long-term care, for members… more
- Molina Healthcare (Tampa, FL)
- …with implementing integrated Behavioral Health care management programs. **Knowledge/Skills/Abilities** Provides Psychiatric leadership for utilization ... **JOB DESCRIPTION** **Job Summary** Molina's Behavioral Health function provides leadership and... Health function provides leadership and guidance for utilization management and case management … more
- Vighter Medical Group (Miami, FL)
- Supervisory Behavioral Health Advisor (SBHA),Local, Miami, Florida Job Details Job Location Miami, FL - Miami, FL Position Type Full Time Education Level ... Percentage Up to 25% Job Shift Any Job Category Health Care Description Title:Supervisory Behavioral Health...of sector wide BH programing to optimize access and utilization . + Provide professional direction, oversight, and consultation of… more
- Molina Healthcare (Tampa, FL)
- …equivalent experience * 2 or more years in case, disease, or utilization management ; managed care; or medical/ behavioral health settings. * Proficient in ... development, implementation, and collaboration with the delivery of training curriculum for Utilization Management , Case Management , and LTSS staff. **Job… more
- Elevance Health (Miami, FL)
- ** Behavioral Health Medical Director- Psychiatrist** Location: Alternate locations may be considered. This position will work a hybrid model (remote and office). ... 50 miles of an Elevance Health Pulse Point location. The ** Behavioral Health Medical Director- Psychiatrist** is responsible for completing medical necessity… more
- Communities Connected for Kids (Port Saint Lucie, FL)
- …innovative methods of quality management /improvement. Review & approve Comprehensive Behavioral Health Assessments (CBHAs) for children placed in out-of-home ... **Description** As a Behavioral Health Specialist at Communities Connected...supervision and served by the CCKids and its' case management providers. This position also coordinates activities required to… more
- CenterWell (Tallahassee, FL)
- …engagement, improving provider capacity by reducing administrative work related to population health management , and assisting patients with the aim of improving ... advocate for improving clinician and patient experience and effectiveness through panel management (aka population health management ) + Comfortable managing… more
- Highmark Health (Tallahassee, FL)
- …of clinical, case/ utilization management and/or disease/condition management experience, or provider operations and/or health insurance experience ... health status/severity and clinical needs; and assesses health management needs of the assigned member...clinical care is being provided. **Preferred** + Certification in utilization management or a related field +… more
- Highmark Health (Tallahassee, FL)
- …timeframes and notification requirements are met + Communicate effectively with Utilization Management Staff, providers, other internal and external customers ... processing of pre-certification requests for authorization of medically necessary health care services at the appropriate level of care,...and management + Route Cases Based on Established Guidelines +… more
- Bluestone Physician Services (Tampa, FL)
- …determinants of health , manage transitions to and from inpatient settings, provide behavioral health support and more. Under our model of care, Bluestone ... with primary care teams to ensure high quality team-based care + Use utilization management tools to facilitate appropriate transitional care management … more
- Elevance Health (Fort Lauderdale, FL)
- …member's circle of support and overall management of the individuals physical health (PH)/ behavioral health (BH)/LTSS needs, as required by applicable ... associates, and may be involved in process improvement initiatives. + Submits utilization /authorization requests to utilization management with documentation… more
- Veterans Affairs, Veterans Health Administration (West Palm Beach, FL)
- …mental health . Incumbent collaborates and participates with facility leadership and Utilization Management to ensure practices follow JC, CARF, and CO ... LOS and flow of patients admitted to our inpatient behavioral health unit, as well as patients...of Care audits and functions as the Department Physician Utilization Management Advisor (PUMA) to ensure compliance.… more
- Highmark Health (Tallahassee, FL)
- …(Claims, Dental Benefits, Customer Service, Membership & Billing), Provider Data Management , Underwriting, and Professional Relations. **This role will support the ... including gathering data from multiple sources related to Benefit/Claim Utilization , Enrollment, Networks ( utilization , disruption, geo-access) and making… more
- HCA Healthcare (Tampa, 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 ... Do you have the career opportunities as a(an) Mental Health Professional III Licensed you want with your current...or experience in the area of clinical practice and/or management + Currently licensed as one of the following… more
- Elevance Health (Miami, FL)
- …A proud member of the Elevance Health family of companies, Carelon Behavioral Health , formerly Beacon Health Options, offers superior clinical mental ... preferred. + Extensive orthopedic surgery experience preferred. + Experience with utilization management , especially with CMS guidelines preferred. For… more