- Humana (Tallahassee, FL)
- …depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an assigned ... of decisions to internal associates, and possible participation in care management . The clinical scenarios predominantly arise...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Humana (Tallahassee, FL)
- …depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an assigned ... with prior experience participating in teams focusing on quality management , utilization management , case ...business metrics. + Experience working with Case managers or Care managers on complex case management , including… more
- Actalent (Sunrise, FL)
- Actalent is hiring a Utilization Management Nurse! Job Description The Utilization Management Nurse (UMN) collaborates closely with the interdisciplinary ... policy guidelines. + Promote safe and appropriate coordination of care and optimal utilization of resources. +...activities as assigned. Essential Skills + Clinical review + Utilization review + Utilization management … more
- Actalent (Sunrise, FL)
- …service utilization . Working under the general supervision of the Director and/or Manager/Supervisor of Medical Management , and in collaboration with ... Utilization Management Nurse!Job Description The ...policy guidelines. + Promote safe and appropriate coordination of care and optimal utilization of resources. +… more
- Monte Nido (Miami, FL)
- …decrease peer to peer reviews. + Communicate emerging trends with insurance companies to Director of Utilization Management . + Maintain database of insurance ... providing the opportunity for people to realize their healthy selves. ** Utilization Review Clinician** **Monte Nido** **Remote** **Monte Nido has been delivering… more
- CVS Health (Tallahassee, FL)
- …Review nurses use specific criteria to authorize procedures/services or initiate a Medical Director referral as needed. + Assists management with training new ... with dedicated colleagues who are passionate about transforming health care . As the nation's leading health solutions company, we...3+ Years of clinical experience. + 1+ Year of Utilization Review Management and/or Medical Management… more
- AdventHealth (Minneola, FL)
- …mind, body and spirit in the Minneola community. **The role you'll contribute:** The Care Management Facility Director has full accountability and oversight ... practice Works collaboratively with leaders of Utilization Management to quickly and efficiently address any Care... Management to quickly and efficiently address any Care Management or Utilization … more
- Evolent (Tallahassee, FL)
- …Clinical Reviewer, Interventional Pain Management , you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... for selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical… more
- Elevance Health (Miami, FL)
- …Accounts Medical Director ** is responsible for serving as the Operational Medical Director for our care management models for our National Account ... medical director supports product strategy/design through medical management that impact health care quality, cost,...the medical director is directly involved in Utilization Management and Case Management .… more
- Select Medical (Gainesville, FL)
- …and to promote cost attentive care via a focus on resource management . + Demonstrating compliance with facility-wide Utilization Management policies and ... **Overview** **Critical Illness Recovery Hospital** ** Director of Case Management ** **$10,000 Sign...growth of the department, including, but not limited to: Utilization Review (UR) and resource management , discharge… more