- 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
- 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...size of region or line of business. The Medical Director conducts Utilization Management of… more