Utilization Manager Jobs in Hialeah, FL (NOW HIRING)

Strong assessment, discharge planning, and utilization review skills Description: The RN Case Manager coordinates patient care plans and services across the continuum of care. Works closely with ...

Participates in utilization management initiatives/opportunities for improvement through departmental and floor committee assignments, including interdisciplinary rounds and LEAN projects.

Clinical Resource Manager (Contract - 12 Weeks) Location: Miami, FL Job Type: Contract (12 Weeks ... Assess patient needs and assist with appropriate level of care and resource utilization. * Monitor ...

Ensures compliance with Utilization Review Annual Plan, JC/DNV-GL, CMS/Federal and State requirements, and professional standards for case management, utilization review/utilization management ...

Utilize case management and utilization management principles to ensure appropriate use of services and adherence to clinical guidelines. * Support Medicaid members by navigating benefits, addressing ...

Utilize case management and utilization management principles to ensure appropriate use of services and adherence to clinical guidelines. * Support Medicaid members by navigating benefits, addressing ...

Utilization Management, Appeals, and Denials * Perform and oversee utilization management reviews related to ophthalmology and vision services. * Conduct medical necessity determinations for prior ...

Utilize case management and utilization management principles to ensure appropriate use of services and adherence to clinical guidelines. * Support Medicaid members by navigating benefits, addressing ...

Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Healthcare members ...

Minimum of two (2) years of experience in clinical review or utilization management Language Skills * Bilingual in English and Spanish (required)

Minimum of two (2) years of experience in clinical review or utilization management Language Skills * Bilingual in English and Spanish (required)

Minimum of two (2) years of experience in clinical review or utilization management Language Skills * Bilingual in English and Spanish (required)

Minimum of two (2) years of experience in clinical review or utilization management Language Skills * Bilingual in English and Spanish (required)

Minimum of two (2) years of experience in clinical review or utilization management Language Skills * Bilingual in English and Spanish (required)

Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Healthcare members ...

Minimum of two (2) years of experience in clinical review or utilization management Language Skills * Bilingual in English and Spanish (required)

... with utilization management and care coordination team. 5. Monitor commercial payers accounts, to include but not limited to: attachment of requested dictation to claims, addition of diagnosis ...

Utilization Management supporting medical necessity and denial prevention. * Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction. * Care ...

Design and implement care delivery models, workflows, and utilization management solutions * Drive measurable improvements in patient flow, capacity, LOS, and avoidable utilization * Partner with ...

Manages utilization management supporting medical necessity, determine appropriate level of care, and resource utilization, and evaluates the need for services for continuity of care and denial ...