- Molina Healthcare (Miami, FL)
- …to produce tools to report, monitor and improve utilization management . * Actively participates in regulatory, professional and community activities. ... of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies… more
- Carnival Cruise Line (Miami, FL)
- This role reports to the Senior Manager of Case Management and oversees the daily operations of crew case management . The Manager leads a team of specialists to ... return-to-work planning. The Manager also escalates high-risk cases, conducts utilization reviews, and represents the company in arbitration when needed.… more
- Elevance Health (Miami, FL)
- …in process improvement initiatives to improve the efficiency and effectiveness of the utilization reviews within the medical management processes. + Assesses and ... **Medical Management Clinician Sr.** **Location:** This role enables associates...a minimum of 6 years of clinical experience and/or utilization review experience. + Current active, valid and unrestricted… more
- Elevance Health (Miami, FL)
- …in process improvement initiatives to improve the efficiency and effectiveness of the utilization reviews within the medical management processes. + Assesses and ... Med Management Clinician Senior- Licensed Nurse **Location:** Miami, FL...a minimum of 4 years of clinical experience and/or utilization review experience. Current active, valid and unrestricted LPN/LVN… more
- University of Miami (Miami, FL)
- …has an exciting opportunity for a full-time Epic Solutions Architect 3, Professional Billing. The Epic Solutions Architect 3 leads the advanced design, development, ... implementation and execution of high complexity and larger impact. Applies project management methodology and utilizes standard project management for software… more
- American Express (Sunrise, FL)
- …SA (SAFe Agilist), PMI-ACP (Agile Certified Practitioner), or PMP (Project Management Professional ) is a plus **Qualifications** Salary Range: $123,000.00 ... + Leads Program Increment (PI) planning meetings with senior leadership, product management , and delivery teams to ensure strategic alignment and readiness + Mentors… more
- Select Medical (Miami, FL)
- …Miami, FL** **$20,000 Sign-on Bonus** **Director of Quality Management ** **(DQM)** **Responsibilities** **Position Summary** Coordinates the Medical Quality ... Management and Performance Improvement activities to measurably enhance the...basic chart review activities with appropriate staff for outcome utilization , infection control and medical CQI indicators. Analyzes results… more
- Molina Healthcare (Miami, FL)
- …health oversight and clinical leadership for health plan and/or market specific utilization management and care management behavioral health programs ... - working closely with regional medical directors to standardize behavioral health utilization management policies and procedures to improve quality outcomes and… more
- University of Miami (Miami, FL)
- …of facilities by coordinating the development of new buildings and negotiating professional service contracts and leases. The Director, Space Planning's goal is to ... + Lead the development and implementation of a comprehensive space management strategy for the academic health campus, encompassing clinical, research, academic,… more
- Florida Atlantic University (Boca Raton, FL)
- …design. Salary: $75,000 - $80,000 per year. College or Department: Facilities Management : Space Utilization and Analysis Administration Location: Boca Raton Work ... Mapping and Documentation Coordinator reports directly to the Director of Space Utilization or designee and serves all University sites and campuses. This position… more
- Elevance Health (Miami, FL)
- …+ Provides guidance for clinical operational aspects of a program. + Perform utilization management reviews to determine medical necessity and appropriateness of ... State agency. **Preferred Qualifications:** + Bilingual- Spanish speaking preferred. + Utilization Management case review experience strongly preferred. +… more
- Molina Healthcare (Miami, FL)
- …ensure appropriate reimbursement to providers. + Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) ... modification of payment decisions. + Serves as a clinical resource for utilization management , CMOs, physicians and member/provider inquiries/appeals. + Provides… more
- Genesis Healthcare (Plantation, FL)
- …management of the rehab department, including oversight related to case management , quality improvement, care planning, clinical utilization , and patient ... Program, and expand your expertise with our Clinicians in Action professional development program Responsibilities The Director of Rehab PT is responsible… more
- Elevance Health (Fort Lauderdale, FL)
- …associates, and may be involved in process improvement initiatives. + Submits utilization /authorization requests to utilization management with documentation ... integrated care plan, engaging the member's circle of support and overall management of the individuals physical health (PH)/behavioral health (BH)/LTSS needs, as… more
- Molina Healthcare (Miami, FL)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... care unit (ICU) or emergency room. Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual /… more
- ChenMed (Miami, FL)
- …our team. The Physician Reviewer is the primary physician reviewer for Utilization Management /Clinical Appropriateness review cases in our organization. Other ... Process and Quality improvement in our developing area of Delegated Utilization Management . **ESSENTIAL JOB DUTIES/RESPONSIBILITIES:** + Provides Delegated… more
- Stantec (Miami, FL)
- …thought leadership in the industry by participating in marque professional conferences, publishing technical papers, conducting webinars and/or podcasts, expanding ... the industry; take on leadership roles in national and international professional trade organizations; and manage effective conference participation within the… more
- Florida Atlantic University (Boca Raton, FL)
- …and Asset Management + Collaborate with Design & Construction, Space Utilization and Analysis, and Budget and Planning teams to ensure building, grounds and ... Raton, FL. Reporting directly to the Assistant Vice President for Facilities Management , the Senior Director of Facilities Operations and Infrastructure is a senior… more
- Elevance Health (Miami, FL)
- …services only, and there is licensed staff supervision. Previous experience in case management / utilization management with a broad range of experience with ... **Preferred Skills, Capabilities and Experiences:** + Experience in behavioral health utilization management is highly preferred. + Exceptional at multitasking… more
- University of Miami (Miami, FL)
- …education, licensure requirements, continuing education, and applicable certifications and professional practice standards. + Responsible for the utilization ... * Assures compliance with all clinical safety standards. * Promotes professional practice models that encourage staff collaboration, teamwork, shared governance,… more