• Utilization Review Nurse

    Actalent (Sunrise, FL)
    …+ Prepare and present reports on department activities as assigned. Essential Skills + Clinical review + Utilization review + Utilization management + ... utilization . Working under the general supervision of the Director and/or Manager/Supervisor of Medical Management, and in collaboration...or LPN License. + Minimum of one year of utilization review experience and discharge planning in… more
    Actalent (08/21/25)
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  • Utilization Management Nurse Consultant…

    CVS Health (Tallahassee, FL)
    …(RN) - active license. + 3+ Years of clinical experience. + 1+ Year of Utilization Review Management and/or Medical Management experience. + Must have active and ... a collaborative process to implement, coordinate, monitor and evaluate medical review cases. + Applies the appropriate clinical criteria/guideline and plan language… more
    CVS Health (08/15/25)
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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 (08/21/25)
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  • Medical Director

    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 (07/19/25)
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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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  • National Accounts Medical Director

    Elevance Health (Tampa, FL)
    …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... impact** : + Day to day clinical responsibilities means that the medical director provides clinical oversight for Utilization Management, Case Management, and… more
    Elevance Health (08/27/25)
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  • Executive Director

    Sevita (FL)
    …status, citizenship, or any other characteristic protected by law._ **Executive Director of Operations** **Starting at $150,000 | Florida-Based Opportunity** Are you ... leader ready to make a meaningful impact? We're seeking a **dynamic Executive Director of Operations** to lead with strategy, vision, and results. + **Starting… more
    Sevita (08/15/25)
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  • Medical Director - National Medicare

    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 ... care industry including Medicare Advantage and Managed Medicaid. + Utilization management experience in a medical management review...size of region or line of business. The Medical Director conducts Utilization Management of the care… more
    Humana (08/21/25)
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  • Director , Physician Leadership - Medical…

    Humana (Tallahassee, FL)
    …role, you will be a key enterprise leader, with responsibility for evolving Humana's Utilization Management of medical review by physician or nurse, with a focus ... The Director , Physician leadership will lead Medical Directors performing utilization management for inpatient authorizations training medical director team… more
    Humana (08/21/25)
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