Clinician

• Provides an integrated EAP service consisting of intake and assessment, support, triage, referrals, clinical case management, and crisis management.
• Provides counseling services in a responsive, efficient, ethical, and professional manner.
• Maintains client confidentiality as required by ethical standards.
• Complies with applicable ethical, therapeutic, and legal standards, as well as the organization’s policies, procedures, and laws.
• Refers clients to appropriate resources and maintains thorough clinical documentation in the computerized system.
• Conducts assessments for substance abuse, mental health, and family issues that may affect work performance.
• Performs initial assessments, crisis intervention, information and referral, and counseling services.
• Makes follow-up calls to clients as needed.
• Performs additional tasks as determined by the clinical management team.
• Facilitates training, and leads and participates in orientation sessions.
• Develops and implements strategic activities for the organization.

Consejero EAP bilingüe apoyando la salud mental de empleados para Workplace Options en Florida

Qualified EAP Clinician

Consejero EAP bilingüe para Workplace Options, proveedor global de apoyo emocional, terapia y coaching. Realizando evaluaciones, asesoramiento, gestión de casos e intervención en crisis.

• Provides an integrated EAP service consisting of intake and assessment, support, triage, referral, clinical case management, and crisis management
• Delivers counseling services in a responsive, efficient, ethical, and professional manner
• Maintains client confidentiality as required by ethical standards
• Adheres to applicable ethical, therapeutic, and legal standards, as well as organizational policies, procedures, and laws
• Refers clients to appropriate resources and maintains thorough clinical documentation in the computerized system
• Conducts assessments for substance abuse, mental health, and family issues that may affect work performance
• Performs initial assessment, crisis intervention, information and referral, and counseling services
• Conducts follow-up calls to clients as necessary
• Performs additional duties as determined by the clinical management team
• Facilitates training, leads and participates in orientation
• Develops and executes strategic activities for the organization

Consejero EAP remoto apoyando salud mental para Workplace Options en Florida

Consejero EAP remoto para Workplace Options, proveedor global de apoyo emocional, terapia y servicios de bienestar. Realizando evaluaciones, asesoramiento, gestión de casos e intervención en crisis.

• Perform medical necessity reviews and authorization determinations
• Monitor and determine if level of care and services related to mental health and substance abuse are medically appropriate
• Evaluate member’s treatment for mental health and substance abuse before, during, and after services
• Perform prior authorization reviews related to mental health and substance abuse to determine medical appropriateness
• Perform concurrent review of behavioral health (BH) inpatient
• Analyze BH member data to improve quality and appropriate utilization of services
• Provide education to providers, members, and their families regarding BH utilization process
• Interact with BH healthcare providers and engage with medical directors and leadership to improve quality

Utilization Review Clinician performing behavioral health reviews remotely

Utilization Review Clinician – Behavioral Health

Utilization Review Clinician performing medical necessity reviews for behavioral health services to ensure members receive appropriate care. Remote role with Centene's Medical Management/Health Services team.

• Performs reviews of member's care and health status of Applied Behavioral Analysis (ABA) services provided to determine medical appropriateness
• Monitors clinical effectiveness and efficiency of member's care in accordance with ABA guidelines
• Evaluates member’s care and health status before, during, and after provision of Applied Behavioral Analysis (ABA) services to ensure level of care and services are medically appropriate related to behavioral health (BH) and/or autism spectrum disorder needs and clinical standards
• Performs prior authorization reviews related to BH to determine medical appropriateness in accordance with ABA regulatory guidelines and criteria
• Analyzes BH member data to improve quality and appropriate utilization of services
• Interacts with BH healthcare providers as appropriate to discuss level of care and/or services provided to members receiving Applied Behavior Analysis Services
• Provides education to members and their families regarding ABA and BH utilization process
• Provides feedback to leadership on opportunities to improve care services through process improvement and the development of new processes and/or policies
• Performs other duties as assigned
• Complies with all policies and standards

Utilization Review Clinician reviewing ABA services for clinical effectiveness at Centene

Utilization Review Clinician – ABA

Utilization Review Clinician at Centene performing reviews of ABA services and monitoring clinical effectiveness. Engaging with healthcare providers and improving care processes as part of Medical Management team.

• Confirms medical services are appropriate based on assigned benefit plan, medical policies, clinical guidelines, plan benefits, and/or scripted algorithms within scope of licensure.
• Handles less complex benefit plans and/or contracts.
• Conducts and may approve precertification, concurrent, retrospective, out-of-network, and/or appropriateness of treatment setting reviews by assessing clinical information against appropriate medical policies, clinical guidelines, and the relevant benefit plan/contract.
• May process a medical necessity denial determination made by a Medical Director.
• Refers complex or non-routine reviews to more senior nurses and/or Medical Directors.
• Does not issue medical necessity non-certifications.

Medical Management Clinician Associate managing plan benefits

Medical Management Clinician Associate – Licensed Nurse

Medical Management Clinician Associate managing plan benefits for healthcare services at Elevance Health. Validating medical necessity and compliance for less complex benefit plans in a virtual role.

• Responsible for moderately complex cases that may require evaluation of multiple variables against guidelines when procedures are not clear
• Work may be facilitated, in part, by algorithmic or automated processes
• Handles moderately complex benefit plans and/or contracts
• Works on reviews that may require guidance by more senior colleagues and/or management
• May serve as a resource to less experienced staff
• Conducts and may approve precertification, concurrent, retrospective, out-of-network, and/or appropriateness of treatment setting reviews by assessing clinical information against appropriate medical policies, clinical guidelines, and the relevant benefit plan/contract
• May process a medical necessity denial determination made by a Medical Director
• May work directly with healthcare providers to obtain and understand clinical information
• Refers complex or unclear reviews to higher level nurses and/or Medical Directors
• May educate members about plan benefits and physicians
• Does not issue medical necessity non-certifications

Medical Management Clinician ensuring appropriate plan benefits administration

Medical Management Clinician

Medical Management Clinician ensuring appropriate and consistent administration of plan benefits. Work virtually with clinical information and medical necessity assessment with Florida-based locations.

• Responsible for complex cases that may require evaluation of multiple variables against guidelines when procedures are not clear
• Serves as a resource to lower-level clinicians and staff
• May collaborate with leadership to assist in process improvement initiatives to improve the efficiency and effectiveness of the utilization reviews within the medical management processes
• Assesses and applies medical policies and clinical guidelines within scope of licensure
• Conducts and may approve pre-certification, concurrent, retrospective, out of network and/or appropriateness of treatment setting reviews by utilizing appropriate medical policies and clinical guidelines in compliance with department guidelines and consistent with the members eligibility, benefits and contract
• May process a medical necessity denial determination made by a Medical Director
• Develops and fosters ongoing relationships with physicians, healthcare service providers and internal and external customers to help improve health outcomes for members
• Refers complex or unclear reviews to higher level nurses and/or Medical Directors
• Educates members about plan benefits and physicians
• Collaborates with leadership in enhancing training and orientation materials
• May complete quality audits and assist management with developing associated corrective action plans
• May assist leadership and other stakeholders on process improvement initiatives
• May help to train lower-level clinician staff

Medical Management Clinician Senior role at Elevance Health

Senior Medical Management Clinician

Medical Management Clinician Senior role focusing on complex cases at Elevance Health. Ensuring appropriate administration of plan benefits and collaborating with healthcare providers.

• Clinician Care Managers facilitate the achievement of client wellness and autonomy through advocacy, assessment, planning, communication, education, resource management, and service facilitation
• Collect and assess patient information pertinent to patient’s history, condition, and functional abilities in order to develop a comprehensive, individualized care management plan that promotes appropriate utilization, and cost-effective care and services
• Based on the needs and values of the client, and in collaboration with all service providers, the clinician links clients with appropriate providers and resources throughout the continuum of health and human services and care settings
• Ensure that the care provided is safe, effective, client-centered, timely, efficient, and equitable
• Clinicians have direct communication among the client, the payer, the primary care provider, and other service delivery professionals
• Interact with other PacificSource personnel to assure quality customer service is provided
• Act as an internal resource by answering questions requiring medical or contract interpretation that are referred from other departments, as well as physicians and providers of medical services and supplies
• Assist employers and agents with questions regarding healthcare resources and procedures for their employees and clients
• Practice and model effective communication skills: both written and verbal
• Utilize and promote use of evidence-based tools
• Utilize lean methodologies for continuous improvement

Care Management Clinician improving client wellness and autonomy at PacificSource

Care Management Clinician

Care Management Clinician facilitating client wellness through assessment and resource management at PacificSource. Collaborating with healthcare providers for effective service delivery and care coordination.

• Collaborate with physicians in the evaluation and analysis of a patient’s need for prosthetic and/or orthotic services; recommend treatment options to physicians when necessary
• Examine and evaluate patient needs in relation to disease and functional loss
• Formulate design of prosthetic and/or orthotic devices
• Select materials, make cast measurements, model modifications, and layouts, taking into account new techniques and materials
• Perform fitting, including static and dynamic alignments
• Evaluate prosthetic and/or orthotic device on patient, adjust to assure fit, function, medical efficacy, and quality of work
• Instruct patient in use of prosthetic and/or orthotic devices
• Identify and reconcile issues/problems to ensure patient satisfaction with devices provided
• Provide follow-up with patients and physicians
• Provide in-service training to physicians and allied health care professionals
• Utilize effective materials management, quality and performance processes to maximize device quality and medical efficacy, maintaining a proper balance with costs and operational/financial performance
• Meet with physicians, case managers and other referral sources to review prosthetic and/or orthotic services and capabilities; develop and enhance business relationships to identify and secure ongoing and future sources or referrals
• Plan and implement strategies to meet and exceed revenue targets in coordination with management
• Provide detailed clinical notes to patient records
• May mentor residents or newly certified clinicians
• Provide assistance to other clinical staff
• Provide information to administrative staff to conduct reimbursement activities
• Adhere to all safety regulations; compliance with Medicare and other governmental regulations; compliance with bloodborne and Occupational Safety and Health Administration (OSHA) requirements
• Perform other duties or special projects as assigned
• May be asked to perform on-call, hospital calls, or float between more than one Hanger Clinic location.

Prosthetist and/or Orthotist role at Hanger, Inc. providing patient care

Prosthetist and Orthotist Clinician, CPO, CO, CP, Board Eligible

Prosthetist and/or Orthotist at Hanger, Inc. providing prosthetic and orthotic patient care services. Collaborate with a team to deliver comprehensive care and improve patient mobility and outcomes.

• Confirms medical services are appropriate based on assigned benefit plan, medical policies, clinical guidelines, plan benefits, and/or scripted algorithms within scope of licensure.
• Work may be facilitated, in part, by algorithmic or automated processes.
• Handles less complex benefit plans and/or contracts.
• Conducts and may approve precertification, concurrent, retrospective, out-of-network, and/or appropriateness of treatment setting reviews by assessing clinical information against appropriate medical policies, clinical guidelines, and the relevant benefit plan/contract.
• May process a medical necessity denial determination made by a Medical Director.
• Refers complex or non-routine reviews to more senior nurses and/or Medical Directors.

Medical Management Clinician Associate at Elevance Health ensuring appropriate administration of plan benefits.

Medical Management Clinician Associate

Medical Management Clinician Associate at Elevance Health ensuring appropriate administration of plan benefits. Role involves reviewing clinical info and assessing medical necessity under relevant guidelines.

• Advise on policies and outcome metrics to ensure evidence‑based, family‑centered care.
• Act as the primary credentialed provider for the group when applying to commercial and Medicaid plans.

Part-time consultant founding clinician for expanding endocrinology services at 3Y Health

Founding Clinician – Endocrinology

Seeking part-time consultant founding clinician to expand 3Y Health's endocrinology services, shaping local care models. Emphasizes flexible work with autonomy and support for building independent practice.

• Advise on policies and outcome metrics to ensure evidence‑based, family‑centered care.
• Act as the primary credentialed provider for the group when we are applying to commercial and Medicaid plans in your state.

Founding Clinician for Infectious Disease services at 3Y Health

Founding Clinician – Infectious Disease

Founding Clinician for Infectious Disease services at 3Y Health, shaping care models and expanding insurance contracts. Work remotely with flexible commitment, supporting independent practice growth.

Founding Clinician for Nephrology services at 3Y Health

Founding Clinician – Nephrology

Founding Clinician for Nephrology services at 3Y Health. Advising on care models and credentialing processes.

Founding Clinician for remote Rheumatology services at 3Y Health

Founding Clinician – Rheumatology

Founding Clinician supporting Rheumatology services at 3Y Health. Advising on patient care policies and insurance contracts as a part-time consultant.

• We are looking for a variable commitment, up to 1 hr commitment per week
• Advise on policies and outcome metrics to ensure evidence‑based, family‑centered care.
• Act as the primary credentialed provider for the group when we are applying to commercial and Medicaid plans in your state.

Founding Clinician providing part-time consultation for Pulmonology at 3Y Health

Founding Clinician – Pulmonology

Founding Clinician providing part-time consultation for Pulmonology at 3Y Health. Shaping local care models and expanding insurance contracts with operational support.

Clinician jobs in Florida

See all jobs on JobTailor

Qualified EAP Clinician

Qualified EAP Clinician

Utilization Review Clinician – Behavioral Health

Utilization Review Clinician – ABA

Medical Management Clinician Associate – Licensed Nurse

Medical Management Clinician

Senior Medical Management Clinician

Care Management Clinician

Prosthetist and Orthotist Clinician, CPO, CO, CP, Board Eligible

Medical Management Clinician Associate

Founding Clinician – Endocrinology

Founding Clinician – Infectious Disease

Founding Clinician – Nephrology

Founding Clinician – Rheumatology

Founding Clinician – Pulmonology