• Medical Director - Florida

    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 ... community and help us put health first** The Medical Director relies on medical background and reviews health claims....with prior experience participating in teams focusing on quality management , utilization management , case … more
    Humana (07/29/25)
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  • Medical Director - NorthEast Region

    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 ... community and help us put health first** The Medical Director relies on medical background and reviews health claims....with prior experience participating in teams focusing on quality management , utilization management , case … more
    Humana (07/25/25)
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  • Senior Medical Director (Medicare)

    Molina Healthcare (Orlando, FL)
    …experience as a Molina Medical Director + Demonstrated experience in Utilization /Quality Program management + Previous leadership experience + Peer review, ... of prior authorization, inpatient concurrent review, discharge planning, case management and interdisciplinary care team activities. + Ensures that authorization… more
    Molina Healthcare (06/13/25)
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  • Utilization Management Nurse

    Actalent (Sunrise, FL)
    Actalent is hiring a Utilization Management Nurse! Job Description The Utilization Management Nurse (UMN) collaborates closely with the interdisciplinary ... present reports on department activities as assigned. Essential Skills + Clinical review + Utilization review + Utilization management + InterQual + Milliman… more
    Actalent (08/21/25)
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  • Utilization Review Nurse

    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 ...utilizing standardized Review Criteria. + Coordinate with the Medical Director /Physicians for requests outside standard Review Criteria. + Maintain… more
    Actalent (08/21/25)
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  • Utilization Management Nurse…

    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 ... active license. + 3+ Years of clinical experience. + 1+ Year of Utilization Review Management and/or Medical Management experience. + Must have active and… more
    CVS Health (08/15/25)
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  • National Director , Care Integration…

    CenterWell (Tallahassee, FL)
    …Coordinate quality improvement activities to address high risk, high-utilizers/high-cost patient management through the utilization of the 5M's framework as ... will play a pivotal role in reducing acute care utilization for top 5% of complex patients and ensuring...highest need and complexity patients with care and case management services. The Director is response for… more
    CenterWell (08/15/25)
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  • Field Medical Director , Pain…

    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 ... + On a requested basis, may function as Medical Director for selecting health plans or regions, assuming overall...selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with… more
    Evolent (08/20/25)
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  • Director of Case Management ( RN…

    Select Medical (Gainesville, FL)
    …focus on resource management . + Demonstrating compliance with facility-wide Utilization Management policies and procedures. + Coordinating UR compliance with ... **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
    Select Medical (08/02/25)
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  • Director Case Management

    HCA Healthcare (Tampa, FL)
    …a part of our team. **Job Summary and Qualifications** The Facility Case Management Director has the overall responsibility for managing and coordinating ... join an organization that invests in you as a Director Case Management ? At HCA Florida South...to ensure continuity of care and optimal clinical resource utilization . The Director has oversight for all… more
    HCA Healthcare (08/20/25)
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