• Medical Director - Commercial

    Elevance Health (Tampa, FL)
    …Coast time zone hours.** The **Medical Director ** will be responsible for utilization review case management for Commercial business in the New England (CT, ... **Medical Director - Commercial** Location: This role enables associates to...state or territory of the United States when conducting utilization review or an appeals consideration and… more
    Elevance Health (07/25/25)
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  • Utilization Review Clinician…

    Monte Nido (Miami, FL)
    …lives while providing the opportunity for people to realize their healthy selves. ** Utilization Review Clinician** **Monte Nido** **Remote - EST or CST hours** ... strategies to provide comprehensive care within an intimate home setting. The Utilization Review **Clinician** is responsible for conducting daily administrative… more
    Monte Nido (06/21/25)
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  • Utilization Management Nurse

    Actalent (Sunrise, FL)
    …UMN assists in complex cases, develops internal processes, and educates physicians on utilization review issues. The role involves managing continuity of care, ... + Prepare and present reports on department activities as assigned. Essential Skills + Clinical review + Utilization review + Utilization management +… more
    Actalent (07/29/25)
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  • Utilization Review - Registered…

    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 ... improvement programs + Addresses facility and departmental communication through daily review of all correspondence, including incoming email messages. + Performs… more
    Community Health Systems (07/12/25)
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  • Medical Director , MSK Surgery

    Evolent (Tallahassee, FL)
    …the support services review process. Responsible for the quality of utilization review determinations, including appeals. + Provides input into audit ... member of the Medical leadership team, providing timely medical review of service requests. Oversees the Surgery Field Medical...needed for new hires to educate and train on Utilization management system and Field Medical Director … more
    Evolent (05/20/25)
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  • Part-time Pediatric / Family Medicine Medical…

    Centene Corporation (Tallahassee, FL)
    …management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , quality ... of physician education with respect to clinical issues and policies. + Identifies utilization review studies and evaluates adverse trends in utilization … more
    Centene Corporation (08/02/25)
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  • Medical Director Physician Advisor UM

    AdventHealth (Altamonte Springs, FL)
    …Utilization Management, the Physician Advisor is responsible for providing clinical review of utilization , claims management, and quality assurance related to ... activities and program development + Provides guidance to clinical questions from Utilization Management staff involved in authorizations, concurrent review , and… more
    AdventHealth (08/07/25)
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  • Field Medical Director , Interventional…

    Evolent (Tallahassee, FL)
    … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director...the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
    Evolent (07/30/25)
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  • Director of Rehab

    Genesis Healthcare (Oxford, FL)
    …Area Director ). 9. Assumes responsibility for daily staffing and utilization with input from treating therapists, consideration of clinical requirements, and ... our Clinicians in Action professional development program. Responsibilities The Director of Rehab PTA is responsible for the efficient... in the timely completion of the annual merit review for therapy staff. 6. Assists Clinical Operations Area… more
    Genesis Healthcare (06/19/25)
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  • Medical Director - Florida

    Humana (Tallahassee, FL)
    …understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer based review of moderately complex to complex ... health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review … more
    Humana (07/29/25)
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