- HCA Healthcare (Gainesville, FL)
- …services and administrative activities including fiscal, material and human resource management .? + Maintains and monitors utilization of resources, physical ... HCA Healthcare colleagues invested over 156,000 hours impacting our communities. As a(an) Director Cardiac Cath Lab with HCA Florida North Florida Hospital, you can… more
- CVS Health (Tallahassee, FL)
- …and consistent responses to members and providers. Leads all aspects of utilization review /quality assurance, directing case management Provides clinical ... the US.** Aetna, a CVS Health Company, has an exciting opportunity for a Medical Director (Spine) that can be remote based, work from home. The Medical Director … more
- Evolent (Tallahassee, FL)
- …review roles that emphasize volume throughput, this position integrates utilization management with collaborative engagement and innovation. **Core ... for individuals facing cancer. As a Performance Suite Medical Director in Medical Oncology, you will play a pivotal...Responsibilities** + **Clinical Review & Peer Collaboration** + Serve as the physician… more
- MTC (Graceville, FL)
- …improvement committee. 7. Closely monitor all potential catastrophic events and perform utilization review and tracking. 8. Submit and implement recommendations ... Medical, Florida Department of Corrections (FDOC) and Florida Department of Management Services (DMS) directives. **Essential Functions:** 1. Support and assist… more
- Sevita (Orlando, FL)
- …day. Join us today, and experience a career well lived. **Regional Director - IDD Services, Central Florida Region** Salary Range: $85,000-$100,000 annually ... quality. + Execute regional core growth strategy to increase census, maximize utilization and occupancy percentages; respond to local requests for proposals to… more
- Highmark Health (Tallahassee, FL)
- …of internal clinical and value-based evaluation committees that drive formulary and utilization management functions. + Participate in product specific Pharmacy ... of implemented initiatives. + Lead product based pharmacy trend management discussions with internal partners including senior executives. +...and Therapeutics Committees and Drug Utilization Review (DUR) Committees as necessary or… more
- Travelers Insurance Company (Tallahassee, FL)
- …skills **What is a Must Have?** + Licensed MD + 5 years clinical and utilization management experience + Certified by the American Board of Medical Specialties ... to keep Travelers at the leading edge of the P&C industry. Develop medical management strategies that help injured employees return to work as soon as medically… more
- Community Health Systems (Naples, FL)
- …Management is responsible for the planning, coordination, and oversight of care management services, including utilization review , discharge planning, and ... efficiently, effectively, and in compliance with organizational standards. + Oversees utilization review and discharge planning processes to ensure… more
- Carnival Cruise Line (Miami, FL)
- …to risk management , legal, HR, and clinical governance teams. + Review crew claims for relevance and appropriateness in coordination with internal and external ... This role reports to the Senior Manager of Case Management and oversees the daily operations of crew case management . The Manager leads a team of specialists to… more
- Elevance Health (Tampa, FL)
- …or case management experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or any combination of education and ... **Must reside in the state of Florida** The **Medical Management Nurse** will be responsible for review ...treatment is medically necessary and provides consultation to Medical Director on cases that are unclear or do not… more