- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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 (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