- Centene Corporation (Tallahassee, FL)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... appropriateness in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine overall… more
- Monte Nido (Miami, FL)
- …save lives while providing the opportunity for people to realize their healthy selves. ** Utilization Review Clinician ** **Monte Nido** **Remote - EST or CST ... clinical strategies to provide comprehensive care within an intimate home setting. The Utilization Review ** Clinician ** is responsible for conducting daily… more
- Actalent (Sunrise, FL)
- Utilization Management Behavioral Health ClinicianUtilization Management Behavioral Health Clinician We're seeking a dedicated Behavioral Health ... this role, you'll collaborate with an interdisciplinary team to review and authorize behavioral health and substance...LCSW, LMSW, LPHA, or LMHC). + 2+ years in utilization review /case management; 1+ year in acute… 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 ... plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. HCS… more
- Molina Healthcare (Tampa, FL)
- **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN in United States who has a compact, multi-state license. This team reviews the prior ... transplants; the ideal candidate will have experience either in utilization review or case management for transplants....an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high… more
- Molina Healthcare (Orlando, FL)
- …Carolina Medicaid Population processing Prior Authorizations, Inpatient Reviews, and Behavioral health services. Strongly prefer candidates with a background on ... utilization management or appeals. Excellent computer multi-tasking skills and...an integrated delivery of care across the continuum, including behavioral health and long term care, for members with… more
- CenterWell (Daytona Beach, FL)
- …performance in patient experience, quality of care, clinical outcomes, and avoidable utilization *Periodically review clinician charts to identify ... and operational budgeting, and monitor clinical & financial performance and metrics. * Review clinician schedules and incentive plans to align with patient… more
- CenterWell (Jacksonville, FL)
- …clinical performance in patient experience, quality of care, clinical outcomes, and avoidable utilization + Periodically review clinician charts to identify ... of health (SDOH) efforts, improving clinical outcomes and avoidable utilization + Monitor and manage daily patient care and...and monitor clinical & financial performance and metrics. + Review clinician schedules and incentive plans to… more