• Physician - Physician Advisor

    Ascension Health (Jacksonville, FL)
    …of recent work experience in a hospital setting, preferably with some Physician Advisory/ Utilization Management work experience. If you are ready to join a ... **Details** + **Specialty** : Case Management + **Subspecialty:** Physician Advisor + **Schedule** : Full Time | Hybrid (frequently on site) + **Call Schedule:** No… more
    Ascension Health (11/12/25)
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  • Care Review Clinician (RN)

    Molina Healthcare (FL)
    …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... room. Preferred Experience Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG… more
    Molina Healthcare (12/13/25)
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  • Licensed Physician Reviewer - Ortho (remote)

    ChenMed (Miami, FL)
    …our team. The Physician Reviewer is the primary physician reviewer for Utilization Management /Clinical Appropriateness review cases in our organization. Other ... Process and Quality improvement in our developing area of Delegated Utilization Management . **ESSENTIAL JOB DUTIES/RESPONSIBILITIES:** + Provides Delegated… more
    ChenMed (10/16/25)
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  • Manager Healthcare Analytics - Medical Policy

    Highmark Health (Tallahassee, FL)
    …of various projects and data analysis related to Medical Policy and Utilization Management . **ESSENTIAL RESPONSIBILITIES** + Perform management ... experience in a supervisory capacity or role **Preferred** + Experience in Utilization Management and/or Medical PolicyExperience working with claims data… more
    Highmark Health (12/24/25)
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  • Director - Case Management (RN) - Acute…

    Ascension Health (Pensacola, FL)
    …(2) years of proven leadership or management experience, preferably overseeing Case Management or Utilization Review teams in an Acute Care setting. + ... **Details** + **Department:** Case Management + **Schedule:** Full time Day Shift +...an annual bonus incentive As the Director of Case Management for our Acute Care Services. This role leads… more
    Ascension Health (12/09/25)
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  • Director PI Bed Management

    HCA Healthcare (Tallahassee, FL)
    …to Patient in Bed by facility by floor to identify opportunities + Assesses utilization of Bed Management technology for optimal use + Performs staffing ... that invests in you as a(an) Director PI Bed Management ? At HCA Healthcare, you come first. HCA Healthcare...We are looking for a dedicated Director PI Bed Management like you to be a part of our… more
    HCA Healthcare (11/26/25)
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  • VP, Medical Economics

    Molina Healthcare (Jacksonville, FL)
    …Tableau and data management . * Advanced understanding health care operations ( utilization management , disease management , HEDIS quality measures, claims ... tracking tools and identify opportunities to improve performance and data management , and support, guide and influence decision-making related to clinical programs,… more
    Molina Healthcare (12/23/25)
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  • Manager Site III

    BayCare Health System (Valrico, FL)
    …The Site Manager III is responsible for: In a complex practice, oversees the utilization management and daily business operations of the physician practice at ... + Responsible for patient access to services, insurance contract verification, utilization management , charge entry, collections, clinical support management more
    BayCare Health System (12/29/25)
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  • Medical Director-Payment Integrity

    Humana (Tallahassee, FL)
    …interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , discharge ... Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a… more
    Humana (12/11/25)
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  • Lead Architect

    Highmark Health (Tallahassee, FL)
    …supporting, and optimizing the architectural strategy for **all clinical and utilization management applications** . Their expertise spans application, solution, ... and AI integration, extending this strategic oversight across **all clinical and utilization management applications** . This involves ensuring the completeness… more
    Highmark Health (12/02/25)
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