- Highmark Health (Tallahassee, FL)
- …Description :** **JOB SUMMARY** This job is responsible for working with HHO clinical departments in the areas of compliance and process improvement. Serves ... as a corporate resource regarding accreditation standards, clinical performance and continuous improvement...maintenance of Care Management policies and procedures to ensure accreditation and compliance with NCQA and DMMA… more
- CVS Health (Tallahassee, FL)
- …and documents care utilizing case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and ... impact member outcomes and care planning with appropriate referral to clinical case management or crisis intervention as appropriate. + Utilizes… more
- CVS Health (Tallahassee, FL)
- …clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures and regulatory ... and/or member's needs to ensure appropriate administration of benefits. + Applies clinical judgment to the incorporation of strategies designed to reduce risk… more
- CVS Health (Tallahassee, FL)
- …clients - Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures and regulatory ... and/or member's needs to ensure appropriate administration of benefits - Applies clinical judgment to the incorporation of strategies designed to reduce risk factors… more
- Humana (Tallahassee, FL)
- …to maximize each beneficiary's capacity for self-care, to cost-effectively achieve desired clinical outcomes and to enhance quality of medical care. The case manager ... of case management involvement. The case manager will serve as the primary coordinator and point of contact for the beneficiary for all activities within the… more