Utilization Management Jobs in New Port Richey, FL

Determines appropriate utilization management of services requested Qualifications What We Look For: * Clear and active RN license in state of FL * 2+ years of acute clinical/surgical position

Hematologist-Oncologist Senior Medical Director of Utilization Management needed to join a practice in Tampa, FL. This position is with a group that is committed to providing quality services in ...

Job Summary The Director - Case Management directs Case Management and Utilization Management activities within a ScionHealth hospital. This role oversees the coordination of care for patients and ...

Underpinned by technology, data, analytics, AI, change management, talent and sustainability ... As aNetwork Performance/Utilization Manager, your primary responsibilitiesmay include: * Advise ...

Utilization Management Medical DirectorPrimary Care Organization | Florida | Full Time Most utilization management roles ask a physician to say no. This one asks you to build the system that makes ...

Managing denial and/or appeal escalations and communicating delays to the Director, Utilization Management Compliance. * Working closely with the Director, Utilization Management Compliance to ...

Managing denial and/or appeal escalations and communicating delays to the Director, Utilization Management Compliance. * Working closely with the Director, Utilization Management Compliance to ...

Managing denial and/or appeal escalations and communicating delays to the Director, Utilization Management Compliance. * Working closely with the Director, Utilization Management Compliance to ...

The Physician Advisor (PA) will drive quality performance across the organization by communicating with hospital physicians, utilization management, case management, CDI, the denials team, and ...

What You'll Do Clinical Review & Utilization Management * Perform clinical reviews of dental claims, prior authorizations, and referrals to ensure timely, accurate, and compliant determinations

What You'll Do Clinical Review & Utilization Management * Perform clinical reviews of dental claims, prior authorizations, and referrals to ensure timely, accurate, and compliant determinations

Serves as an integral team member to assess and influence clinical resource utilization in the acute care setting through collegial interaction with Utilization Review, Case Management, and Clinical ...

Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical information. Minimum Requirements: * Requires a H.S. diploma or equivalent ...

Preferred CCM (Case Manager) Education: * Required Associates in Nursing or * Required Bachelors in Nursing * Preferred Masters in Nursing or Business Experience: * Required 2 years in Utilization ...

Standardizes behavioral health-related utilization management, quality, and financial goals across all lines of businesses. Responds to behavioral health-related requests for proposal (RFP) sections ...

Essential Job Duties Performs audits in utilization management, care management, member assessment, behavioral health, and/or other clinical teams, and monitors clinical staff for compliance with ...

Essential Job Duties Performs audits in utilization management, care management, member assessment, behavioral health, and/or other clinical teams, and monitors clinical staff for compliance with ...

Supports plan utilization management program and accompanying action plan(s), which includes strategies to ensure high-quality member care - ensuring members receive the most appropriate care at the ...

Responsible for the development, implementation, and delivery of training curriculum for utilization management, care management, and long-term services and supports (LTSS) staff. Leads classes ...

In a minimally complex practice, oversees the utilization management and daily business operations of the physician practice at the facility. * Possesses a clear understanding of the financial ...