- Actalent (Sunrise, FL)
- …activities as assigned. Essential Skills + Clinical review + Utilization review + Utilization management + Interqual + Milliman Commercial Guidelines ... utilization . Working under the general supervision of the Director and/or Manager/Supervisor of Medical Management , and...+ Valid Florida Driver's License. + Knowledge of case management and utilization review concepts,… more
- CVS Health (Tallahassee, FL)
- …Nurse (RN) - active license. + 3+ Years of clinical experience. + 1+ Year of Utilization Review Management and/or Medical Management experience. + Must ... nurses use specific criteria to authorize procedures/services or initiate a Medical Director referral as needed. + Assists management with training new nurse… more
- 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
- 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, ... **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
- 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
- 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
- Centene Corporation (Tallahassee, FL)
- …functions for the business unit. + 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
- 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
- Sevita (FL)
- …and leadership skills to a team-based workplace that puts people first. As Executive Director of Operations Management , you will be responsible for operational ... states to increase census, maintain occupancy, improve daily attendance, and maximize utilization . + **Financial Management :** + Oversee billing to ensure… more