- Humana (Tallahassee, FL)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The Medical Director … more
- Humana (Tallahassee, FL)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... of our caring community and help us put health first** The Medical Director actively uses their medical background, experience, and judgement to make determinations… more
- Humana (Tallahassee, FL)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... a part of our caring community and help us put health first** The Medical Director relies on medical background and reviews health claims. The Medical Director … more
- HCA Healthcare (Kissimmee, FL)
- …and external agencies to ensure continuity of care and optimal clinical resource utilization . The Director has oversight for all aspects of daily hospital ... We care like family! Jump-start your career as a Director Case Management today with HCA Florida Osceola Hospital....vary by location._** Come join our team as a(an) Director Case Management. We care for our community! Just… more
- Molina Healthcare (Orlando, FL)
- …HMO/Managed Care experience **OR** 5 years experience as a Molina Medical Director + Demonstrated experience in Utilization /Quality Program management + Previous ... leadership experience + Peer review, medical policy/procedure development, and provider contracting experience + Current clinical knowledge + Experience demonstrating strong management and communication skills, consensus building and collaborative ability, and… more
- Monte Nido (Miami, FL)
- …while providing the opportunity for people to realize their healthy selves. ** Utilization Review Clinician** **Monte Nido** **Remote - EST or CST hours** **Monte ... to provide comprehensive care within an intimate home setting. The Utilization Review **Clinician** is responsible for conducting daily administrative and… more
- CVS Health (Tallahassee, FL)
- …day. **Position Summary** **Fully remote with requirement to reside in Florida.** + Utilization Management is a 24/7 operation and the work schedule may include ... use specific criteria to authorize procedures/services or initiate a Medical Director referral as needed. **Required Qualifications** + Must have active, current… more
- Community Health Systems (Naples, FL)
- **Job Summary** Under the direction of the UR Director /Manager the UR Nurse reviews all admissions for medical necessity, correct orders based on medical condition ... accommodation for any part of the application or hiring process, contact the director of Human Resources at the facility to which you are seeking employment;… more
- AdventHealth (Altamonte Springs, FL)
- …role you will contribute:** The Physician Advisor provides primary support for Utilization Management (UM) and secondary support for Care Management (CM) departments ... Advisor is responsible for educating, informing and advising members of the Utilization Management, Care Management, Managed Care and Revenue Cycle departments and… more
- Evolent (Tallahassee, FL)
- …training classes as needed for new hires to educate and train on Utilization management system and Field Medical Director process, standards and resources. ... for the culture. **What You'll Be Doing:** The Medical Director for MSK Surgery is a key member of...support services review process. Responsible for the quality of utilization review determinations, including appeals. + Provides input into… more