- Humana (Tallahassee, FL)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... caring community and help us put health first** The Medical Director relies on medical ...healthcare providers, clinical group practice management . + Utilization management experience in a medical… more
- Humana (Tallahassee, FL)
- … Director , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an ... caring community and help us put health first** The Medical Director relies on medical ...healthcare providers, clinical group practice management . + Utilization management experience in a medical… more
- Elevance Health (Miami, FL)
- …responsibilities means that the medical director is directly involved in Utilization Management and Case Management . + Daily case reviews for both ... Director ** is responsible for serving as the Operational Medical Director for our care management...director provides clinical expertise in all aspects of utilization review and case management . Provides input… more
- Molina Healthcare (Orlando, FL)
- …as a Molina Medical Director + Demonstrated experience in Utilization /Quality Program management + Previous leadership experience + Peer review, ... Summary** Responsible for serving as the primary liaison between administration and medical staff. Assures the ongoing development and implementation of policies and… more
- Actalent (Sunrise, FL)
- Actalent is hiring a Utilization Management Nurse! Job Description The Utilization Management Nurse (UMN) collaborates closely with the interdisciplinary ... and appropriateness using standardized Review Criteria. + Coordinate with the Medical Director /Physicians for requests outside standard Review Criteria. +… more
- CVS Health (Tallahassee, FL)
- …nurses use specific criteria to authorize procedures/services or initiate a Medical Director referral as needed. + Assists management with training new nurse ... Years of clinical experience. + 1+ Year of Utilization Review Management and/or Medical Management experience. + Must have active and unrestricted RN… more
- Monte Nido (Miami, FL)
- …decrease peer to peer reviews. + Communicate emerging trends with insurance companies to Director of Utilization Management . + Maintain database of insurance ... and potential for private payment. + Follow workflow and medical record requirements for utilization review and...Follow workflow and medical record requirements for utilization review and clinical documentation across programs. + Leverage… more
- DOCTORS HEALTHCARE PLANS, INC. (Miami, FL)
- Position Summary: The Director of Medical Management is responsible for the strategic direction, leadership, and oversight of all medical management ... initiatives and programs. + Oversees a staff of Hospital Reviewers/ Utilization Managers, Medical Management Coordinator...+ At least 3-5 years in a leadership or director -level role managing teams. + Strong knowledge of regulatory… more
- Evolent (Tallahassee, FL)
- …for utilization management while working in conjunction with the Senior Medical Director . May assist the Senior Medical Director in ... , you will be a key member of the utilization management team. We can offer you...process. + On a requested basis, may function as Medical Director for selecting health plans or… more
- Select Medical (Gainesville, FL)
- …focus on resource management . + Demonstrating compliance with facility-wide Utilization Management policies and procedures. + Coordinating UR compliance with ... **Overview** **Critical Illness Recovery Hospital** ** Director of Case Management ** **$10,000 Sign...in social work and minimum three (3) years of medical case management or similar experience._** **Previous… more