Medical Management Nurse Elevance Health IncMedical Management NurseMiami, FL$75,772–$113,658 / yearHow you will make an impact: Utilizes nursing judgment and reasoning to analyze members' clinical information, interface with healthcare providers, make assessments based on clinical presentation, and apply clinical guidelines and/or policies to evaluate medical necessity. The Medical Management Nurse is responsible for review of the most complex or challenging cases that require nursing judgment, critical thinking, and holistic assessment of member's clinical presentation to determine whether to approve requested service(s) as medically necessary.
Medical Management Specialist I Elevance HealthMedical Management Specialist IMiami, FloridaWe are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. Primary duties may include, but are not limited to: Gathers clinical information regarding case and determines appropriate area to refer or assign case (utilization management, case management, QI, Med Review).
Care Management - Nurse, Senior Blue Cross and Blue Shield AssociationCare Management - Nurse, SeniorFLIn this role you will determine, develop and implement the plan of care based on accurate assessment of the member and current or proposed treatment plan in cases of member inquiry, triage hub, chronic conditions, poly-pharmacy, pre-natal care, and voluntary member health assessment, in addition to indication of multiple monthly ER visits. Recognize the clients right to self-determination as it relates to the ethical principle of autonomy, including the client/family''s right to make informed choices that may not promote the best outcomes, as determined by the healthcare team.
Medical Director Utilization Management Oncology Starling OncologyMedical Director Utilization Management OncologyMiami, FLRemote$275,000–$325,000 / yearFormerly known as The Oncology Institute, Starling Oncology offers cutting-edge, evidence-based cancer care to a population of approximately 2.1 million patients, including clinical trials, transfusions, and other care delivery models traditionally associated with the most advanced care delivery organizations. The Medical Director role provides clinical expertise in assessing the medical necessity, appropriateness, and efficiency of oncology care with a focus on direct utilization management for case review and clinical decision making.
Utilization Management Clinical Dental Processor Avesis LLCUtilization Management Clinical Dental ProcessorFL$18.33–$30.55 / hourFunctional Competencies: Conducts reviews of prior authorizations by providers -- determining cases of recommended treatment in accordance with Avesis UM procedural guidelines or refers the case to Clinical Director or consultant for professional review of clinical denials. Maintains effective intradepartmental communications through sharing of plans, general company news and other information through informal interactions; and actively participates in routine departmental meetings.
NewMedical Management Specialist I Elevance Health IncMedical Management Specialist IMiami, FLHow you will make an impact: Gathers clinical information regarding case and determines appropriate area to refer or assign case (utilization management, case management, QI, Med Review), including triaging information from the shared mailbox. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
Intensive Community Manager, Complex Care RN ChenMedIntensive Community Manager, Complex Care RNWest Park, FloridaThe Intensive Community Care Manager (ICCM) is a Registered Nurse (RN) who works with our highest complexity patients, their primary care physicians, and other members of the care team that provides hyperfocus case management and field nursing interventions to prevent unnecessary hospital arrivals, keep patients engaged in our intensive primary care model and maximize their healthy time at home. They will assess, evaluate, and coordinate the team’s efforts to stabilize our highest risk patients, with special areas of focus including safe transitions of care from facilities back to our primary care teams, stabilization of our highest risk ambulatory patients and outreach to patients who are assigned to us but are not engaged in care.
Care Manager Independent Living Systems LLCCare ManagerFort Lauderdale, FLThe Care Manager collaborates closely with multidisciplinary teams, including healthcare providers, social workers, and community resources, to facilitate access to Medicaid and other support services. ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations.
Client Support Assistant II - Social Services Care Resource Community Health Centers, Inc.Client Support Assistant II - Social ServicesMiami, FLProvides services required by following established protocols and when needed, procure additional help to answer questions to ensure appropriate services are delivered. Listens to the internal or external customer (i.e. patient, client, staff, vendor) attentively, reassuring and understanding of the request and providing appropriate options or resolutions.
CLIENT SUPPORT ASSISTANT II - Social Services Care Resource Community Health Centers, Inc.CLIENT SUPPORT ASSISTANT II - Social ServicesMiami, FLProvides services required by following established protocols and when needed, procure additional help to answer questions to ensure appropriate services are delivered. Listens to the internal or external customer (i.e. patient, client, staff, vendor) attentively, reassuring and understanding of the request and providing appropriate options or resolutions.
GUARDIAN AD LITEM OFFICE, 11TH CIRCUIT-OPS CHILD ADVOCATE MANAGER- 21811009 Government of FloridaGUARDIAN AD LITEM OFFICE, 11TH CIRCUIT-OPS CHILD ADVOCATE MANAGER- 21811009MIAMI, FLSome examples of a "typical" working day may include the following: Collaborate with the Guardian ad Litem Office multidisciplinary team, management, Department of Children and Families, contracted service providers, Department of Juvenile Justice, Department of Education, Law Enforcement, etc. The Statewide Guardian ad Litem Office is Florida's award-winning, state-funded child advocacy organization that provides independent legal representation to abused, abandoned and neglected children in Florida's dependency court proceedings.
Social Support Complex Care Coordinator-2 ChenMed LLCSocial Support Complex Care Coordinator-2Miami, FL$49,871–$71,243 / yearThe Social Support Complex Care Coordinator (SSCCC) serves as the central hub for managing PCP referrals related to social support, acute patient needs, and behavioral health concerns - connecting patients to the right in-house care teams, community resources, and payer-supported programs before unmet needs escalate into medical crises. Demonstrate working knowledge of Medicare Advantage, Medicaid, and commercial insurance payer systems, including plan benefits, care management programs, eligibility and enrollment, Medicare Savings Programs (MSPs), Low Income Subsidy (LIS/Extra Help), prior authorization processes, Non-Emergency Medical Transportation (NEMT) benefits, and Medicare Advantage supplemental benefits.
NewOutreach Care Specialist (Us)-7 Elevance HealthOutreach Care Specialist (Us)-7Miami, FLThe Outreach Care Specialist is responsible for ensuring that appropriate member treatment plans are followed on less complex cases and for proactively identifying ways to improve the health of our members and meet quality goals. For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Pediatric Social Worker (Part Time w/ Benefits, Days) Nicklaus Children's HospitalPediatric Social Worker (Part Time w/ Benefits, Days)Miami, FLKnowledge of community resource systems, diverse treatment approaches, Florida state laws regarding child abuse and domestic violence, Baker Act procedures, HIV/AIDS related guidelines, and Social Work theories/practices. Makes decisions in a self-directed manner, consults with supervisor or director regarding complex cases and discusses pertinent cases with fellow social workers.
Outreach Care Specialist (US)-7 Elevance Health IncOutreach Care Specialist (US)-7Miami, FLWe are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. Hybrid 1 (1 day): This role requires associates to be in-office 1 day per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance.
Social & Family Domain Lead (Remote) MaximusSocial & Family Domain Lead (Remote)Miami, FLRemoteFull timeMaximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. - Working knowledge of family systems, human services principles, social support networks, community resources, and prevention-focused programming.
Outreach Housing Specialist/ Family Street Outreach- Bilingual Spn-Eng Care Resource Community Health Centers, Inc.Outreach Housing Specialist/ Family Street Outreach- Bilingual Spn-EngFort Lauderdale, FLThe Outreach Housing Specialist is responsible for coordinating the assessment to Individual and Families with Homeless needs and subsequent engagement for Shelters, Rapid Re-housing, Permanent Support Housing, and referral to access medical, dental, mental health, substance use disorder care, pharmaceutical, treatment education, and other services needed by Care Resource clients. Outreach Housing Specialist participate in homeless coalition meetings, coordinated entry case conferencing, maintain appropriate client data in client case file, the Homeless Management Information System (HMIS), and PATH-specific data systems, including spreadsheets and grant-prescribed data systems.
Outreach Housing Specialist Care Resource Community Health Centers, Inc.Outreach Housing SpecialistFort Lauderdale, FLThe Outreach Housing Specialist is responsible for coordinating the assessment to Individual and Families with Homeless needs and subsequent engagement for Shelters, Rapid Re-housing, Permanent Support Housing, and referral to access medical, dental, mental health, substance use disorder care, pharmaceutical, treatment education, and other services needed by Care Resource clients. Outreach Housing Specialist participate in homeless coalition meetings, coordinated entry case conferencing, maintain appropriate client data in client case file, the Homeless Management Information System (HMIS), and PATH-specific data systems, including spreadsheets and grant-prescribed data systems.
Temporary Social Services Associate Nova Southeastern UniversityTemporary Social Services AssociateFort Lauderdale-Davie, FLRequired Certifications/Licensures: Supervised related professional experience, including direct care, case management and community resource linkage Required Education: Bachelor's degree Major (if required: Human service-related field (social work, sociology, psychology, human services, public health Required Experience: • Supervised experience in case management Excellent organizational skills and attention to detail Display strong work ethic, personal integrity, empathy. Actively manage a caseload of patients with ALS and ensure needs are met Work with the providers with the multidisciplinary clinic team and maintain strong communication with clinic staff Provides in-service education programs to clinic staff, patients and caregivers, local hospice, home health agencies, hospitals, skilled care facilities and other state social service agencies as needed.
Population Health & C3 Social Worker I South Florida Community Care NetworkPopulation Health & C3 Social Worker ISunrise, FLThis position is integral to the holistic management of patients' health, focusing on psychosocial interventions that complement medical care, promote patient engagement, and facilitate access to necessary resources and services, ultimately contributing to the overall improvement of patient outcomes and the efficient use of healthcare resources. Proficient in Team Building and Collaboration: Experience in building and participating in cross-functional teams, with a strong ability to facilitate coordination, communication, and collaboration among care team members to achieve goals and maximize positive member outcomes.