• Utilization Review Nurse

    Actalent (Sunrise, FL)
    …appropriateness, utilizing standardized Review Criteria. + Coordinate with the Medical Director /Physicians for requests outside standard Review Criteria. ... service utilization . Working under the general supervision of the Director and/or Manager/Supervisor of Medical Management, and in collaboration with… more
    Actalent (08/21/25)
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  • Utilization Review Clinician

    Monte Nido (Miami, FL)
    …authorization, potential denials, and potential for private payment. + Follow workflow and medical record requirements for utilization review and clinical ... while providing the opportunity for people to realize their healthy selves. ** Utilization Review Clinician** **Monte Nido** **Remote** **Monte Nido has been… more
    Monte Nido (08/28/25)
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  • Utilization Management Nurse Consultant…

    CVS Health (Tallahassee, FL)
    …(RN) - active license. + 3+ Years of clinical experience. + 1+ Year of Utilization Review Management and/or Medical Management experience. + Must have active ... a collaborative process to implement, coordinate, monitor and evaluate medical review cases. + Applies the appropriate...use specific criteria to authorize procedures/services or initiate a Medical Director referral as needed. + Assists… more
    CVS Health (08/15/25)
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  • Utilization Management Nurse

    Actalent (Sunrise, FL)
    …and appropriateness using standardized Review Criteria. + Coordinate with the Medical Director /Physicians for requests outside standard Review Criteria. ... complex cases, develops internal processes, and educates physicians on utilization review issues. The role involves managing...assigned caseload. + Serve as a liaison between the Medical Director , physicians, and office staff to… more
    Actalent (08/21/25)
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  • National Accounts Medical Director

    Elevance Health (Miami, FL)
    …The medical director provides clinical expertise in all aspects of utilization review and case management. Provides input on the clinical relevance to ... day clinical responsibilities means that the medical director is directly involved in Utilization Management...state or territory of the United States when conducting utilization review or an appeals consideration and… more
    Elevance Health (08/27/25)
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  • Medical Director

    Centene Corporation (Tallahassee, FL)
    … management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , ... perspective on workplace flexibility. **Position Purpose:** Assist the Chief Medical Director to direct and coordinate the... review studies and evaluates adverse trends in utilization of medical services, unusual provider practice… more
    Centene Corporation (07/19/25)
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  • Medical Director Physician Advisor…

    AdventHealth (Altamonte Springs, FL)
    …assists in drafting and submitting clinical denial appeals, as needed + Develops Medical Director relationships with payors to have open communication and ... Management, the Physician Advisor is responsible for providing clinical review of utilization , claims management, and quality...+ Provides education and serves as a resource to Medical Staff colleagues regarding best practices, Utilization … more
    AdventHealth (08/07/25)
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  • Field Medical Director…

    Evolent (Tallahassee, FL)
    …non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your expertise in interventional ... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National...process. + May assist the Senior Medical Director in research activities/questions related to the Utilization… more
    Evolent (07/30/25)
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  • Medical Director - National Medicare

    Humana (Tallahassee, FL)
    …will understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer-based review of moderately complex ... Medicaid. + Utilization management experience in a medical management review organization, such as Medicare...on size of region or line of business. The Medical Director conducts Utilization Management… more
    Humana (08/21/25)
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  • Director , Physician Leadership…

    Humana (Tallahassee, FL)
    …role, you will be a key enterprise leader, with responsibility for evolving Humana's Utilization Management of medical review by physician or nurse, with ... performing utilization management for inpatient authorizations training medical director team to assist and facilitate...**Key Responsibilities** **:** + Lead an operational team of Medical Directors to review authorizations and ensure… more
    Humana (08/21/25)
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