- CVS Health (Tallahassee, FL)
- …No weekends or holidays. + 1+ years of utilization review/ utilization management required. + 3+ years of behavioral health clinical experience in a ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable… more
- Centene Corporation (Tallahassee, FL)
- …licensed and located in FL. Ideal candidate will have experience in Utilization Management .** **Education/Experience:** Requires Graduate of an Accredited School ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… 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
- Actalent (Sunrise, FL)
- … Behavioral Health Clinician We're seeking a dedicated Behavioral Health Clinician to join our Utilization Management team. In this role, you'll ... Utilization Management Behavioral Health ClinicianUtilization Management … more
- Molina Healthcare (Orlando, FL)
- …Behavioral health services. Strongly prefer candidates with a background on utilization management or appeals. Excellent computer multi-tasking skills and ... Medical, or ER unit. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). To all current Molina… more
- Molina Healthcare (St. Petersburg, FL)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... / MCG guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). MULTI STATE / COMPACT… more
- Molina Healthcare (Tampa, FL)
- …requests for transplants; the ideal candidate will have experience either in utilization review or case management for transplants. Preference will be ... **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN in United States who has...an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high… more
- CenterWell (Daytona Beach, FL)
- …in patient experience, quality of care, clinical outcomes, and avoidable utilization *Periodically review clinician charts to identify opportunities in ... our primary care team, combining clinical practice with leadership and operational management to ensure high-quality patient care and alignment with Value-Based Care… more
- CenterWell (Jacksonville, FL)
- …performance in patient experience, quality of care, clinical outcomes, and avoidable utilization + Periodically review clinician charts to identify opportunities ... our primary care team, combining clinical practice with leadership and operational management to ensure high-quality patient care and alignment with Value-Based Care… more
- CenterWell (Tallahassee, FL)
- …care that affect patient care and population management , such as quality management , utilization management , network management , and payment ... patients at national scale. S/he will be a proven clinician , leader, and strategist capable of driving the highest...quality/STARS, efficiency of care, and improved clinical outcomes and utilization . + Identify and act on opportunities to better… more
- Elevance Health (Plant City, FL)
- …telephonic or face-to-face assessments for the identification, evaluation, coordination and management of member's needs, including physical health, behavioral ... **LTSS Service Coordinator - Clinician (Bilingual in Spanish/English)** **Location: This is a...health care team, to ensure cost effective and efficient utilization of health benefits. + Decision making skills will… more