- 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
- 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
- Actalent (Sunrise, FL)
- …appropriate service utilization . Working under the general supervision of the Director and/or Manager/Supervisor of Medical Management , and in ... development. This role involves close interaction with Medical Directors and other Medical Management staff to direct utilization and capture data… 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
- 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
- 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. + ... 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