- 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 actively uses their 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
- 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)
- …every day. **Position Summary** **Fully remote with requirement to reside in Florida.** + Utilization Management is a 24/7 operation and the work schedule may ... use specific criteria to authorize procedures/services or initiate a Medical Director referral as needed. **Required Qualifications**...in Florida + 3+ years of clinical experience + Utilization Management is a 24/7 operation and… more
- Monte Nido (Miami, FL)
- …Medicare medical necessity criteria. 7. Communicates with Revenue Cycle Management and Contracting regarding billing/claims issues and status of single case ... while providing the opportunity for people to realize their healthy selves. ** Utilization Review Clinician** **Monte Nido** **Remote - EST or CST hours** **Monte… 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
- AdventHealth (Altamonte Springs, FL)
- …serves as a resource to Medical Staff colleagues regarding best practices, Utilization Management and Care Management structures, and functions and use ... will contribute:** The Physician Advisor provides primary support for Utilization Management (UM) and secondary support for...and submitting clinical denial appeals, as needed + Develops Medical Director relationships with payors to have… more
- Centene Corporation (Tallahassee, FL)
- …the Chief Medical Director to direct and coordinate the medical management , quality improvement and credentialing functions for the business unit. This ... + Provides medical leadership of all for utilization management , cost containment, and medical...performance improvement initiatives for capitated providers. + Assists Chief Medical Director in planning and establishing goals… more