• Utilization Review Nurse

    Actalent (Sunrise, FL)
    …direct utilization and capture data effectively. Responsibilities + Review prior authorization requests for medical necessity and appropriateness, utilizing ... a liaison between the Medical Director, physicians, and office staff, resolving prior authorization issues. + Communicate denial determinations to providers when… more
    Actalent (07/16/25)
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  • Supervisor , Intensive Community Care…

    ChenMed (Winter Park, FL)
    …rapidly expanding and we need great people to join our team. The Supervisor , Intensive Community Care, RN is a multi-market leadership position responsible for ... guidance to their team. Directly reporting to the Manager of ICC, this Supervisor is responsible for their teams members assigned patient case load whose role… more
    ChenMed (06/27/25)
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  • Supervisor , Clinical Pharmacy/MTM - Remote

    Molina Healthcare (Orlando, FL)
    …this family include those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns ... and comply with CMS guidelines. These staff may also be involved in providing utilization management/ prior authorization services as needed. * Supervises the… more
    Molina Healthcare (07/09/25)
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  • Document Specialist Supervisor - SES - 1

    MyFlorida (Spring Hill, FL)
    DOCUMENT SPECIALIST SUPERVISOR - SES - 64041156 1 Date: Jul 22, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify ... 857224 Agency: Department of Health Working Title: DOCUMENT SPECIALIST SUPERVISOR - SES - 64041156 1 Pay Plan: SES...back up to Medical Records Tech, process medical records, authorization to disclose. HMS clinic schedule maintenance. Patient Flow… more
    MyFlorida (07/23/25)
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  • Physician (Mental Health) - Associate Chief…

    Veterans Affairs, Veterans Health Administration (Miami, FL)
    …follows a capabilities model to achieve goals for eligibility, referral and authorization , care coordination, and utilization management to ensure improved ... improving the Veteran's experience and outcomes. Defines mental health policies, utilization management process and procedures, financial and utilization reports… more
    Veterans Affairs, Veterans Health Administration (06/28/25)
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  • Reimbursement Solutions Analyst

    Cardinal Health (Tallahassee, FL)
    …is to provide a detailed outline of clearance criteria as well as prior authorization and advocacy identification for procedures and medications scheduled to ... to representatives for benefit investigation as well as clinical clearance for prior authorization and medical necessity + Extensive patient education/counseling… more
    Cardinal Health (07/18/25)
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