• Clinical Letter Writer - UM & Specialty…

    Evolent (Tallahassee, FL)
    …Appropriately identifies and refers quality issues to the Senior Director of Medical Management or Medical Director . + Appropriately identifies potential ... write clearly. + Reviews adverse determinations against criteria and medical policies + Creates adverse determination notifications that meet...patient care + **Minimum one year of experience with Utilization Review ( UM ) in a managed care… more
    Evolent (04/25/25)
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  • Utilization Management RN Remote

    AdventHealth (Altamonte Springs, FL)
    …which have been referred to the physician for peer-to-peer review with the Medical Director of the insurance carrier. **The expertise and experiences you'll ... **The role you will contribute:** The role of the Utilization Management ( UM ) Registered Nurse (RN) is...physician advisor to avoid concurrent denials. 8) Collaborates with medical staff, nursing staff, payor, and ancillary staff to… more
    AdventHealth (05/14/25)
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  • Medical Director Specialty…

    Molina Healthcare (Jacksonville, FL)
    **JOB DESCRIPTION** **Job Summary** The Medical Director for Specialty Medical Services & Market Performance will provide clinical expertise and support to ... at the most effective setting. Evaluates the effectiveness of UM practices. Actively monitors for over and under- utilization...activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. +… more
    Molina Healthcare (04/09/25)
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  • Medical Director (Medicare)

    Molina Healthcare (Tampa, FL)
    …quality improvement activity (QIA) in collaboration with the clinical lead, the medical director , and quality improvement staff. + Facilitates conformance to ... at the most effective setting. Evaluates the effectiveness of UM practices. Actively monitors for over and under- utilization...experience, including: + 2 years previous experience as a Medical Director in a clinical practice. +… more
    Molina Healthcare (05/02/25)
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  • Associate Medical Director…

    Evolent (Tallahassee, FL)
    …Stay for the culture. **What You'll Be Doing:** Evolent is seeking an **Associate Medical Director - Cardiovascular Medicine** to play a critical role in ... developing cardiovascular programs that include improvements to clinical effectiveness of utilization management ( UM ) and risk-based models.** + Process… more
    Evolent (03/04/25)
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  • Medical Director , Behavioral Health

    Molina Healthcare (Tampa, FL)
    …Board Certification in Psychiatry **REQUIRED EXPERIENCE:** * 2 years previous experience as a Medical Director in clinical practice * 3 years' experience in ... practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment, disease… more
    Molina Healthcare (04/26/25)
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  • Medical Director - Commercial…

    CVS Health (Tallahassee, FL)
    …System eg, Clinical Practice and Health Care Industry. *Prior UM ( Utilization Management) experience *Active and current state medical license without ... have Internal Medicine or Internal Medicine/Pediatrics (Med/Peds) Board Certification. In the Medical Director role, you will provide oversight for medical… more
    CVS Health (05/16/25)
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  • Director , Energy Management & Controls

    University of Miami (Miami, FL)
    …Time Director , Energy Management Systems to work at the UHealth Medical Campus. The Director , Energy Management Systems oversees the organization's energy ... Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . Director , Energy Management Systems The University of Miami/UHealth department… more
    University of Miami (04/06/25)
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  • Executive Director , Clinical Operations

    University of Miami (Miami, FL)
    …"UHealth", Department of Pediatrics has an exciting opportunity for a Full-Time Executive Director , Clinical Operations to work in Miami. The Executive Director , ... + Optimizes staffing models, patient throughput and satisfaction, and ensures efficient utilization of exam room resources. + Implements new programs to create… more
    University of Miami (04/28/25)
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  • OPO Organ Allocation Coordinator 1

    University of Miami (Miami, FL)
    …logistical knowledge of organ donation/recovery process in a timely manner. + Keeps UM LAORA Clinical Operations Director and Organ Allocation and Recovery ... responsible for all activities related to the allocation and utilization of organs from donors. Including, organ allocation for...of recovered organs when necessary. + Familiar with all medical aspects of organ donation and bring any questions… more
    University of Miami (05/15/25)
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