• BCBA-D ABA UM Reviewer

    Humana (Tallahassee, FL)
    …explain the rationale behind utilization management decisions, + Work includes computer- based review of moderately complex to complex clinical scenarios, ... least 2 years of experience post-training providing clinical services . Experience in utilization management review and case management in a health plan setting… more
    Humana (05/07/25)
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  • Acute Care Nurse, HCT (Registered Nurse)

    ChenMed (Lakeland, FL)
    …of 2 years' clinical work experience required. + A minimum of 1 year of utilization review and/or case management, home health, hospital discharge planning ... conferences to review treatment goals, optimize resource utilization , provide family education and identify home ...patients' progress and adjust and plan accordingly. + Understanding utilization review and how to leverage with… more
    ChenMed (04/15/25)
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  • Field Medical Director, Interventional Cardiology…

    Evolent (Tallahassee, FL)
    utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... the mission. Stay for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to make a… more
    Evolent (04/30/25)
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  • Chief Medical Officer

    HCA Healthcare (Tallahassee, FL)
    …a data-driven environment of quality and cost improvement, and develops systems to review utilization of resources and objectively measure outcomes of care in ... for appeals and denials process, discharge planning, case management, and utilization review /management. + Consults with facility-level staff regarding delegated… more
    HCA Healthcare (05/02/25)
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  • Chief Medical Officer

    HCA Healthcare (Panama City, FL)
    …a data-driven environment of quality and cost improvement, and develops systems to review utilization of resources and objectively measure outcomes of care in ... support for appeals and denials process, discharge planning, case management, and utilization review /management + You will consult with facility-level staff… more
    HCA Healthcare (04/23/25)
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  • Medical Director (Medicare)

    Molina Healthcare (Tampa, FL)
    … management, risk management, risk adjustment, disease management, and evidence- based guidelines. + Experience in Utilization /Quality Program management ... and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource… more
    Molina Healthcare (05/02/25)
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  • Medical Director Specialty Medical Services…

    Molina Healthcare (Jacksonville, FL)
    … management, risk management, risk adjustment, disease management, and evidence- based guidelines. + Experience in Utilization /Quality Program management ... and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource… more
    Molina Healthcare (04/09/25)
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  • Field Medical Director, UM Physical Medicine

    Evolent (Tallahassee, FL)
    …a profound impact on the lives of our members. **What you'll be doing:** Utilization Management + Supports pre-admission review , utilization management, and ... review process. + Participates in risk management, claim adjudication, pharmacy utilization management, catastrophic case review , outreach programs, + Assists… more
    Evolent (05/13/25)
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  • Field Medical Director, Cardiology

    Evolent (Tallahassee, FL)
    utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... Director you will be a key member of the utilization management team. We can offer you a meaningful...the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
    Evolent (05/16/25)
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  • Divisional Director of Care Management, Strategy…

    CenterWell (Tallahassee, FL)
    …consistent and standardized program workflows, dyad communication/partnership, and quarterly business review of acute care and post-acute care utilization . + ... and coordinating care to reduce acute and post-acute care utilization . The Divisional Director role is a hybrid with...organization. This must include the ability to drive a team- based approach and work as an interdisciplinary team to… more
    CenterWell (05/06/25)
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