Austin , TX Clinical & Nursing
Description: Position Purpose\: Perform duties to conduct and manage the day to day operations of the utilization management function. Communicate with staff to facilitate daily department functions. Review analyses of activities, costs, operations and forecast data to determine progress toward stated goals and objectives. Promote compliance with federal and state regulations and contractual agree...
Tampa , FL Clinical & Nursing
Description: Position Purpose\: Perform onsite review of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations Complete medical necessity and level of care reviews for requested services using clinical ju...
McAllen , TX Clinical & Nursing
Description: Position Purpose\: Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care. Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provide...
McAllen , TX Clinical & Nursing
Description: Position Purpose\: Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care. Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provide...
Sunrise , FL Clinical & Nursing
Description: Please Note\: This is field-based position primarily serving Dade and Broward counties along with the greater Ft. Lauderdale/Miami area. Position Purpose\: Perform onsite review of emergent/urgent and continued stay requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director wi...
Sunrise , FL Clinical & Nursing
Description: Position Purpose\: Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to prior authorization requests. Perform telephonic review of prior authorization requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Ph...
Orlando , FL Clinical & Nursing
Description: Position Purpose\: Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to prior authorization requests. Perform telephonic review of prior authorization requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Ph...
Dallas , TX Clinical & Nursing
Description: Position Purpose\: Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care. Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provide...
Maitland , FL Clinical & Nursing
Description: Position Purpose\: Supervise the day to day operations of the case management function. This will be a 50% field based position. Implement policies and procedures through oversight for non-routine or complex cases and present to management Assist in recruitment efforts in accordance to the staff to member ratio Coordinate the training of care management staff through maintaining manua...
San Antonio , TX Clinical & Nursing
Description: Position Purpose\: Perform care management duties to assess, plan and coordinate all aspects of medical and supporting services across the continuum of care for select members to promote quality, cost effective care. Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provide...
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