• Registered Nurse (On call)

    MTC (Quincy, FL)
    …record or other forms as appropriate. + Practice basic cost containment and utilization management for inmate care and facility operations. + Maintain absolute ... of Florida with an acceptable driving record required, unless waived by management . Management & Training Corporation (MTC) is an Equal Opportunity Employer. All… more
    MTC (08/02/25)
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  • Case Manager Registered Nurse

    CVS Health (Tallahassee, FL)
    …appropriate member care. . Attends and participates in case rounds, including utilization management rounds for behavioral health and physical health to ... and/or face to face assessing, planning, implementing, and coordinating all care management activities with members to evaluate the medical and behavioral health… more
    CVS Health (07/31/25)
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  • Acute Care Case Manager , Registered Nurse…

    ChenMed (North Miami Beach, FL)
    …years' clinical work experience required. + A minimum of 1 year of utilization review and/or case management , home health, hospital discharge planning experience ... to preferred providers. + Coordinates the integration of social services/case management functions in the pre-acute, ER, acute and post-acute setting. Coordinates… more
    ChenMed (05/28/25)
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  • Medical Director - Medicare Appeals

    CVS Health (Tallahassee, FL)
    …Delivery System eg, Clinical Practice and Health Care Industry. *Prior UM ( Utilization Management ) experience *Active and current state medical license without ... provide oversight for medical policy implementation. You will support the Medical Management staff ensuring timely and consistent responses to members and providers.… more
    CVS Health (08/08/25)
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  • Major & Strategic Account Executive - Hospital…

    Wolters Kluwer (Tallahassee, FL)
    …including: + Conducting regular account review meetings and reviewing account utilization management reporting to provide recommendations + Overseeing contract ... + Closely managing the deal through closure and keeping management informed of any risks or delays + Retaining...level and other key decision makers + Excellent account management skills and ability to manage external and internal… more
    Wolters Kluwer (07/24/25)
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  • Senior Manager, Procurement, Third Party Risk…

    Bristol Myers Squibb (Tampa, FL)
    …measurement skills. + Procurement process knowledge, supplier selection, contract management , supplier management , technology utilization , strategic ... the position of Senior Manager, Procurement, Third Party Risk Management . The Senior Manager will perform duties within the...place as per the in-force enterprise Third Party Risk Management (TPRM) Standards and functional SOPs. On the on-going… more
    Bristol Myers Squibb (08/09/25)
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  • Associate Medical Director

    Elevance Health (Miami, FL)
    …**Carelon Medical Benefits Management ** **Post Acute Care Benefit Utilization Management ** **Schedule: 10:00-7:00 Central Time** **​** **Virtual:** This ... Operations Associate Medical Director** is responsible for supporting the medical management staff ensuring timely and consistent medical decisions to members and… more
    Elevance Health (08/08/25)
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  • Controller

    HCA Healthcare (Oviedo, FL)
    …business opportunities, strategic planning, revenue and reimbursement enhancement, cost and utilization management , and improved operational performance. In this ... hospital/division operations as assigned + Prepare materials for presentations to senior management as assigned + Assist with the preparation of annual budget,… more
    HCA Healthcare (08/08/25)
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  • Medical Director-Medicaid (ABH FL)

    CVS Health (Tallahassee, FL)
    …review, and appeal request. This position is primarily responsible for Utilization Management , including prior authorization and precertification as well ... The Medical Director is part of a centralized team that supports the Medical Management staff and may support other health plans as needed. The Medical Director will… more
    CVS Health (08/08/25)
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  • Health Plan Pharmacy Services Manager (SC…

    Molina Healthcare (Miami, FL)
    …strategy. **KNOWLEDGE/SKILLS/ABILITIES** + Provides oversight and direction to Centralized Pharmacy Utilization Management team + Acts as liaison to internal ... + Develops policies and procedures as needed. + Participates in Quality Management and Health Education programs including, but not limited to, NCQA Accreditation,… more
    Molina Healthcare (07/24/25)
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