- 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...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Highmark Health (Tallahassee, FL)
- …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... and DOL regulations at all times. In addition to utilization review , the incumbent participates as the...member of the multidisciplinary team for case and disease management . They will advise the multidisciplinary team on cases,… more
- Molina Healthcare (Miami, FL)
- …**Job Summary** Molina's Behavioral Health function provides leadership and guidance for utilization management and case management programs for mental ... management programs. **Knowledge/Skills/Abilities** Provides Psychiatric leadership for utilization management and case management ...all LOBs * Responds to BH-related RFP sections and review BH portions of state contracts * Assist the… more
- HCA Healthcare (Sun City Center, FL)
- …Healthcare Quality) OR CHCQM (Diploma in American Board of Quality Assurance and Utilization Review Physicians). _Individuals without CPHQ or_ CHCQM _will be ... today!** **Job Summary and Qualifications** We are seeking a Director of Quality Management . As our ...a healthcare environment + Previous experience in accreditation, quality, utilization management , or risk management … more
- Molina Healthcare (Jacksonville, FL)
- …learn new programs. Preferred Qualifications * Experience with utilization /quality program management . * Managed care experience. * Peer review experience. * ... of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies… more
- HCA Healthcare (Coral Springs, FL)
- …to include but not limited to: Clinical initiatives that impact drug utilization , clinical education and staff development, management of appropriate drug ... plan that ensures positive patient outcomes and appropriate drug utilization + Analyze drug spend trends to identify areas...growth, we encourage you to apply for our Division Director Clinical Pharmacy Services opening. We promptly review… more
- Evolent (Tallahassee, FL)
- …Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. . ... Oncology, you will be a key member of the utilization management team. We can offer you... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- MyFlorida (Fort Myers, FL)
- ASSISTANT COMM HEALTH NURSING DIRECTOR - 64006245 1 Date: Dec 4, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify ... No: 866288 Agency: Department of Health Working Title: ASSISTANT COMM HEALTH NURSING DIRECTOR - 64006245 1 Pay Plan: Career Service Position Number: 64006245 Salary:… more
- Florida Atlantic University (Boca Raton, FL)
- …Boca Raton, FL. Reporting directly to the Assistant Vice President for Facilities Management , the Senior Director of Facilities Operations and Infrastructure is ... and Asset Management + Collaborate with Design & Construction, Space Utilization and Analysis, and Budget and Planning teams to ensure building, grounds and… more
- Molina Healthcare (Tampa, 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