• RN UM Clinical Appeals Nurse Remote

    Molina Healthcare (Orlando, FL)
    …Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM), ... medical officer on denial decisions. * Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. * Identifies… more
    Molina Healthcare (11/14/25)
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  • Surgical Onsite Specialist - (Tampa FL)

    Medtronic (Tampa, FL)
    …lives. The Surgical Onsite Specialist (SOS) is responsible for providing case support and customer support, training and education, and solution implementation ... Surgical Centers of Therapy (COTs). This role ensures seamless product utilization by assisting with on-site procedures, addressing customer inquiries, performing… more
    Medtronic (11/19/25)
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  • Cardiology Medical Director

    Elevance Health (FL)
    …mandated policies, and CMS Coverage Determinations, as applicable. + Perform physician-level case review of utilization requests for procedures and interventions ... make an impact:** + Ensures timely completion of clinical case reviews for their board certified specialty. + Makes...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
    Elevance Health (11/12/25)
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  • PCO Medical Director - UM - Part Time (Hourly)

    CenterWell (Tallahassee, FL)
    …teams focusing on transitions of care, quality management,utilizationmanagement, case management, discharge planning and/or home health or post-acute ... of business metrics. + Experience working with Casemanagersor Caremanagerson complex case management, including familiarity with social determinants of health. + The… more
    CenterWell (11/06/25)
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  • Child Protective Investigator Supv-SES

    MyFlorida (Daytona Beach, FL)
    …Support Worker Group Home Worker Teacher's Assistant/Aide Family Intervention Specialist EMT Case Manager Other welfare, education or professional jobs that ... plan and direct workloads, work flows, deadlines, work objectives and time utilization of subordinate staff in the delivery of protecting children, working with… more
    MyFlorida (11/21/25)
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  • Healthcare Clinical Documentation Specialist

    Deloitte (Tampa, FL)
    …CDIP, CCM) + Experience as clinical registered nurse, physician, physician assistant, case manager , clinical documentation specialist, utilization review, ... skills to collaborate with clinicians, physicians, NP/PAs, ancillary departments, Quality, Case Management, Finance, Revenue Cycle, and Coders + Other skills include… more
    Deloitte (11/21/25)
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  • Field Clinical Specialist, Tampa - Transcatheter…

    Edwards Lifesciences (Tampa, FL)
    …will make an impact:** + Working independently in the areas of valve crimping, case management, pre- case planning, post- case management, 3 Mensio management, ... educational material during training sessions in order to drive utilization of the Edwards's THV product portfolio. + Utilizing...and crimping of the Sapien valve in each assigned case ; to support Physicians in the THV procedure to… more
    Edwards Lifesciences (11/14/25)
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  • Social Work Specialist

    AdventHealth (New Smyrna Beach, FL)
    …Social Work Specialist, in collaboration with the patient/family, care manager nurses, nurses, physicians and the interdisciplinary team, ensures patient-centered ... is under the general supervision of the Care Management Supervisor or Manager and is responsible for patient evaluations of post-hospital needs; development of… more
    AdventHealth (11/20/25)
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  • Behavioral Health Medical Director-Psychiatrist…

    Elevance Health (Tampa, FL)
    …clinical operational aspects of a program. + Conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss ... Director Associates. + Works independently with oversight from immediate manager . + May be responsible for an entire clinical...state or territory of the United States when conducting utilization review or an appeals consideration and cannot be… more
    Elevance Health (11/19/25)
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  • Program Director

    Sevita (Jacksonville, FL)
    …snapshots and evaluations for direct reports in consultation with the PD's manager ; reviews and approves Direct Support Professional and other staff member's ... in decisions regarding discipline and termination in consultation with the PD's manager and Human Resources; manages the termination of Direct Support Professionals… more
    Sevita (11/19/25)
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