- 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 (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
- 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
- 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 (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
- 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
- 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
- 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
- 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
- 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