- Molina Healthcare (Jacksonville, FL)
- …learn new programs. Preferred Qualifications * Experience with utilization /quality program management . * Managed care experience. * Peer review experience. * ... health oversight and clinical leadership for health plan and/or market specific utilization management and care management behavioral health programs… more
- Community Health Systems (Naples, FL)
- Join us as a **Registered Nurse (RN) - Utilization Review position** at Physicians Regional Collier Unit: Utilization Review Shift: Mon-Fri (this is an ... 401k match & more available for Full and Part-Time roles **Job Summary** The Utilization Review Nurse - RN reviews hospital admissions, extended stays, and… more
- Humana (Tallahassee, FL)
- …. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately..., depending on the line of business. The Medical Director conducts Utilization Management or… 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 ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality… more
- Select Medical (Gainesville, FL)
- …functions and professional growth of the department, including, but not limited to: Utilization Review (UR) and resource management , discharge planning, ... focus on resource management . + Demonstrating compliance with facility-wide Utilization Management policies and procedures. + Coordinating UR compliance with… more
- Select Medical (Lake Worth, FL)
- …functions and professional growth of the department, including, but not limited to: Utilization Review (UR) and resource management , discharge planning, ... **Overview** **Critical Illness Recovery Hospital** ** Director of Case Management ** **$10,000 Sign...resource management . + Demonstrating compliance with facility-wide Utilization Management policies and procedures. + Coordinating… more
- HCA Healthcare (Atlantis, FL)
- …personal growth, we encourage you to apply for our Director Case Management opening. We promptly review all applications. Highly qualified candidates will be ... Apply Today! **Job Summary and Qualifications** The Facility Case Management Director has the overall responsibility for...to ensure continuity of care and optimal clinical resource utilization . The Director has oversight for all… more
- Centene Corporation (Tallahassee, FL)
- …reside in Florida + Board certified in Pediatrics or Family Medicine + Utilization Management experience and knowledge of quality accreditation standards. + ... functions for the business unit. + Provides medical leadership of all for utilization management , cost containment, and medical quality improvement activities. +… more
- Humana (Tallahassee, FL)
- …. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately...Director - North Central Medicaid Markets. The Medical Director conducts Utilization Management of… more
- Evolent (Tallahassee, FL)
- …impact on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your ... Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
