Sunshine Health Utilization Management

Listing Websites about Sunshine Health Utilization Management

Utilization Management Sunshine Health

(8 days ago) WebThe Sunshine Health utilization management program serves to: Ensure confidentiality of personal health information. Initiate process improvement activities to enhance …

https://www.sunshinehealth.com/providers/utilization-management.html

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Providing Quality Care - Sunshine Health

(8 days ago) WebUtilization Management (UM) decisions are based only on the appropriateness of care and service and the existence of coverage. Sunshine Health does not reward providers, …

https://www.sunshinehealth.com/providers/quality-improvement/quality-care.html

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Sunshine Health Member Healthcare Resources Sunshine Health

(7 days ago) WebSunshine Health is committed to providing our members with the resources they need to get the best care possible. In this section, we provide information, education and …

https://www.sunshinehealth.com/members/smi/resources.html

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Care Management Sunshine Health

(3 days ago) WebContact your child’s Care Manager’s supervisor. If you don’t know who your child’s care manager’s supervisor is, call Member Services at 1-866-796-0530 (TTY 1-800-955-8770 …

https://www.sunshinehealth.com/members/smi/resources/care-management.html

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Contact Us Sunshine Health

(6 days ago) WebAmbetter: 1-833-750-1160. For questions on the formulary or a drug that is provided through a retail pharmacy or specialty pharmacy call. Ambetter, Medicaid, Serious Mental Illness …

https://www.sunshinehealth.com/providers/contact-us.html

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Portal for Members Login Sunshine Health

(1 days ago) WebSunshine Health offers many convenient and secure tools to assist you. You also have access to your healthcare information. To enter our secure portal, click on the login …

https://www.sunshinehealth.com/login.html

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Supervisor, Utilization Management, Remote-FL + 1 other location

(8 days ago) WebYou could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a …

https://jobs.centene.com/us/en/jobs/1496638/supervisor-utilization-management/

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Incentives Statement Provider Resources Sunshine Health

(6 days ago) WebIncentives Statement. Sunshine Health does not reward practitioners, providers, or employees who perform utilization reviews, including those of the delegated entities for …

https://www.sunshinehealth.com/content/sunshine-new/en_us/providers/utilization-management/incentives-statement.html

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Continuity of Care Sunshine Health

(1 days ago) WebWhat rates does Sunshine Health pay during the COC period? Providers with additional questions about Continuity and Coordination of Care or who need further assistance can …

https://www.sunshinehealth.com/content/sunshine-new/en_us/providers/utilization-management/continuity-and-continuation-of-care.html

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Florida Medicaid & Health Insurance Sunshine Health

(2 days ago) WebA session will be held on June 27, 2024, from 1:30 to 4 p.m. Eastern. Sunshine Health offers affordable Florida Medicaid, Medicare Plans and our Health …

https://www.sunshinehealth.com/.

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Provider Quick Reference Guide - Sunshine Health

(4 days ago) WebThe Sunshine Health Medical Management team provides oversight of utilization management, case management and care coordination. Authorization must be …

https://www.sunshinehealth.com/content/dam/centene/Sunshine/pdfs/Provider-Quick-Reference-Guide-PDF1.pdf

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Clinical & Payment Policies Provider Resources Sunshine Health

(2 days ago) WebYou may access the InterQual ® SmartSheet(s)™ for Adult and Pediatric procedures, durable medical equipment and imaging procedures by logging into the secure provider …

https://www.sunshinehealth.com/content/sunshine-new/en_us/providers/utilization-management/clinical-payment-policies.html/

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Manuals, Forms and Resources Sunshine Health

(Just Now) WebSunshine Health Payment Policies; Provider Payment forms. Provider Dispute Form (PDF) W-9 Form (PDF) Medical Management Prior Authorization Resource. Medicare Pre …

https://www.sunshinehealth.com/resources

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POLICY AND PROCEDURE

(9 days ago) Webfor Sunshine Health to make utilization management (UM) decisions and notifications to the member; the member’s PCP, practitioner, and provider in a timely manner. See …

https://www.sunshinehealth.com/content/dam/centene/Sunshine/policies/clinical-policies/LT.UM.11.pdf

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POLICY AND PROCEDURE

(9 days ago) WebUtilization Management. EFFECTIVE DATE: 12/01/2018 . PRODUCT(S): Managed Medical Assistance (MMA) REVIEWED/REVISED DATE: SCOPE: Sunshine Health …

https://www.sunshinehealth.com/content/dam/centene/Sunshine/policies/clinical-policies/FL.UM.64.pdf

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Resource Guide - Sunshine Health

(4 days ago) WebAssistance with coordinating appointments and other services post discharge, linking member to benefits and community services, education on medications and condition(s) …

https://www.sunshinehealth.com/content/dam/centene/Sunshine/pdfs/MMA-PRO-CM-Resource-Guide.pdf

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POLICY AND PROCEDURE

(9 days ago) WebThe Sunshine Health utilization management staff receives the authorization request for services to be done at a specialized acute care hospital. Once it is determined that a …

https://www.sunshinehealth.com/content/dam/centene/Sunshine/policies/clinical-policies/FL.UM.34.pdf

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Member Services Sunshine Health

(6 days ago) WebContacting Member Services. You may call us at 1-866-796-0530, or TTY at 1-800-955-8770, Monday through Friday, 8 a.m. to 8 p.m., but not on state approved holidays (like …

https://www.sunshinehealth.com/members/medicaid/benefits-services/member-services.html

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(5 days ago) WebBehavioral Health Utilization Management covers mental health and substance use services. Phone number: 1-844-477-8313, Select the Product (Option 3 for MMA, 4 for …

https://www.sunshinehealth.com/content/dam/centene/Sunshine/pdfs/SH-PRO-CM-Resource%20Guide.pdf

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Florida Healthcare & Medicaid Plans Sunshine Health

(1 days ago) WebWe believe local partnerships enable meaningful, accessible healthcare. Sunshine Health is a Florida Medicaid health plan and a wholly-owned subsidiary of Centene Corporation, …

https://www.sunshinehealth.com/content/sunshine-new/en_us/about-us.html

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POLICY AND PROCEDURE

(9 days ago) WebSunshine Health has timeframes in place for providers/members to notify Sunshine Health of a service request and for Sunshine Health to make utilization management (UM) …

https://www.sunshinehealth.com/content/dam/centene/Sunshine/policies/clinical-policies/FL.UM.12.pdf

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OTC Benefit Sunshine Health

(4 days ago) WebOrder by phone at 1-888-262-6298, Monday through Friday, 9 a.m. to 8 p.m. Eastern to have items shipped to your home. Shop in person at select CVS stores. …

https://www.sunshinehealth.com/members/medicaid/benefits-services/pharmacy/otc-mobile-app.html

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Contact Us Florida Medicaid Sunshine Health

(3 days ago) WebPlease fill out the below form or contact us at 1-866-796-0530 . Your inquiry will be reviewed. A Sunshine Health representative may contact you regarding your inquiry. If …

https://www.sunshinehealth.com/content/sunshine-new/en_us/contact-us.html

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