- 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
- Monte Nido (Miami, FL)
- …while providing the opportunity for people to realize their healthy selves. ** Utilization Review Clinician** **Monte Nido** **Remote** **Monte Nido has been ... within an intimate home setting. We are seeking a Utilization Review Clinician to join our team...reviews. + Communicate emerging trends with insurance companies to Director of Utilization Management. + Maintain database… 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
- Elevance Health (Miami, FL)
- …members. The medical director provides clinical expertise in all aspects of utilization review and case management. Provides input on the clinical relevance ... Day to day clinical responsibilities means that the medical director is directly involved in Utilization Management...state or territory of the United States when conducting utilization review or an appeals consideration and… 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
- 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 ... health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review … more