• Med Mgmt Nurse (US)

    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 ... - 6pm EST and will include weekends. 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
    Elevance Health (07/30/25)
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  • Medical Director - Commercial

    Elevance Health (Tampa, FL)
    …East Coast time zone hours.** The **Medical Director ** will be responsible for utilization review case management for Commercial business in the New ... **Medical Director - Commercial** Location: This role enables associates to...state or territory of the United States when conducting utilization review or an appeals consideration and… more
    Elevance Health (07/25/25)
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  • Utilization Management Nurse

    Actalent (Sunrise, FL)
    …activities as assigned. Essential Skills + Clinical review + Utilization review + Utilization management + InterQual + Milliman Commercial Guidelines ... education and experience. + Valid Florida Driver's License. + Knowledge of case management and utilization review concepts, including InterQual and Milliman… more
    Actalent (07/29/25)
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  • Utilization Review Clinician…

    Monte Nido (Miami, FL)
    …lives while providing the opportunity for people to realize their healthy selves. ** Utilization Review Clinician** **Monte Nido** **Remote - EST or CST hours** ... strategies to provide comprehensive care within an intimate home setting. The Utilization Review **Clinician** is responsible for conducting daily administrative… more
    Monte Nido (06/21/25)
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  • Director of Case Management ( RN…

    Select Medical (Gainesville, 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
    Select Medical (08/02/25)
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  • Medical Director Physician Advisor UM

    AdventHealth (Altamonte Springs, FL)
    …program development + Provides guidance to clinical questions from Utilization Management staff involved in authorizations, concurrent review , and denials + ... , the Physician Advisor is responsible for providing clinical review of utilization , claims management ,...submitting clinical denial appeals, as needed + Develops Medical Director relationships with payors to have open communication and… more
    AdventHealth (08/07/25)
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  • Part-time Pediatric / Family Medicine Medical…

    Centene Corporation (Tallahassee, FL)
    …must be a Florida resident. + Provides medical leadership of all for utilization management , cost containment, and medical quality improvement activities. + ... on workplace flexibility. **Position Purpose:** Assist the Chief Medical Director to direct and coordinate the medical management...Performs medical review activities pertaining to utilization review… more
    Centene Corporation (08/02/25)
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  • Director Case Management

    HCA Healthcare (Kissimmee, 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
    HCA Healthcare (06/21/25)
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  • Medical Director , MSK Surgery

    Evolent (Tallahassee, FL)
    …classes as needed for new hires to educate and train on Utilization management system and Field Medical Director process, standards and resources. + Acts as ... the support services review process. Responsible for the quality of utilization review determinations, including appeals. + Provides input into audit… more
    Evolent (05/20/25)
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  • Field Medical Director , Interventional…

    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
    Evolent (07/30/25)
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