• Medical Director - Medical Oncology

    Elevance Health (FL)
    …to members and providers. **How you will make an impact:** + Perform physician-level case review , following initial nurse review , of Medical Oncology ... regimens and supportive care. + Perform physician-level case review , following initial nurse review...maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care. + Participate… more
    Elevance Health (09/27/25)
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  • Medical Management Coordinator, RN

    DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
    …insurance environment. + Minimum 2 years of experience with pre-authorization, utilization review /management, case management, care coordination, and/or ... criteria. Responsibilities: + Manages appropriate cases that require medical necessity review such as home care, elective inpatient and outpatient service requests.… more
    DOCTORS HEALTHCARE PLANS, INC. (09/14/25)
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  • RN Clinical Appeals Nurse

    Molina Healthcare (Orlando, FL)
    …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... unrestricted Certified Clinical Coder + Certified Medical Audit Specialist + Certified Case Manager + Certified Professional Healthcare Management + Certified… more
    Molina Healthcare (09/26/25)
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  • RN Lead, Healthcare Services

    Molina Healthcare (FL)
    …License must be active and unrestricted in state of practice. * Certified Case Manager (CCM), Certified Professional in Health Care Management certification ... supporting one or more of the following functions: care management, utilization management, care transitions, long-term services and supports (LTSS), behavioral… more
    Molina Healthcare (09/26/25)
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  • Social Worker (MSW) - Per Diem

    Trinity Health (Fort Lauderdale, FL)
    …care team. Keeps patient/family, payer/physician apprised and updated. Communicates specific issues to Manager of Case Manager , Medical Advisor and hospital ... therapy, etc. + Completes comprehensive assessment of patient situations utilizing Case Management documentation standards, review of medical record,… more
    Trinity Health (09/27/25)
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  • Executive Director, Utilities and Energy…

    University of Miami (Miami, FL)
    …staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . Executive ... cost, service delivery excellence, and strategic planning for future resource utilization and availability. 4. Participates in negotiations for the purchase of… more
    University of Miami (09/24/25)
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  • Infusion Referral Nurse Sr- REMOTE

    Prime Therapeutics (Tallahassee, FL)
    …clinical experience. + Experience in managed care, specialty drugs, care management and utilization review . + Meets Credentialing criteria. + At minimum must ... for drug services. + Will actively maintain a required case load and the activities to reach overall goals...Quality oversight for this program is provided by the Manager , Patient Programs. **Minimum Qualifications** + Associates - Nursing… more
    Prime Therapeutics (09/04/25)
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  • Associate Medical Director

    CenterWell (Daytona Beach, FL)
    …in patient experience, quality of care, clinical outcomes, and avoidable utilization *Periodically review clinician charts to identify opportunities in ... coaching initiatives are precise *Identify critical issues for high-risk patients during case reviews & other forums, and modeling and driving clinical excellence… more
    CenterWell (09/11/25)
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  • Home Care Supervisor, RN

    BayCare Health System (Bradenton, FL)
    …the Emergency Management program for office and agency staff. + Participates with Case Manager on initial Plan of Care review with a focus on quality, ... within the area of responsibility. + Ensure quality assurance program and utilization review is followed in accordance with Home Care protocol. + Oversees and… more
    BayCare Health System (08/22/25)
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  • Associate Medical Director

    CenterWell (Jacksonville, FL)
    …performance in patient experience, quality of care, clinical outcomes, and avoidable utilization + Periodically review clinician charts to identify opportunities ... precise + Identify critical issues for high-risk patients during case reviews & other forums, and modeling and driving...of health (SDOH) efforts, improving clinical outcomes and avoidable utilization + Monitor and manage daily patient care and… more
    CenterWell (07/22/25)
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