- Actalent (Sunrise, FL)
- Job Title: Behavioral Health Utilization Review NurseJob Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing requests ... Qualifications + Valid Florida Driver's License. + Knowledge of case management and utilization review concepts, including InterQual and Milliman Criteria. +… more
- Monte Nido (Miami, FL)
- …are looking for a Director of Utilization Management to oversee the Utilization Management / Review team and function. This role with report to the SVP ... the opportunity for people to realize their healthy selves. **Director of Utilization Management ** **Monte Nido** **Remote** Monte Nido has been delivering… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …safe discharge coverage for all hospital units. + Participates in utilization management initiatives/opportunities for improvement through departmental committee ... the State of Florida. + 3 years minimum experience in discharge planning, utilization management , or case management . + Basic proficiency in Microsoft Word,… more
- ChenMed (Miami, FL)
- …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
- Centers Plan for Healthy Living (Margate, FL)
- …currently accepting applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works within a ... care or support in their home to improve their quality of life. Utilization Management Clinical Reviewer will assess and process all authorization requests… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …a plus. Experience: + Minimum 5-10 years of progressively responsible experience in medical management , or utilization review within a healthcare plan, ACO, ... responsible for the strategic direction, leadership, and oversight of all medical management functions, including Utilization Management , and Quality… more
- Evolent (Tallahassee, FL)
- …Reviewer , Interventional Pain Management , you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... Will Be Doing:** + Serve as the Physician Clinical Reviewer for Interventional Pain Management , reviewing cases... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- CenterWell (Tallahassee, FL)
- …a part of our caring community and help us put health first** Utilization Management Administration Coordinator II , non-clinical, supports the UM operations ... smooth workflows and effective communication while handling the administrative side of utilization management . **Use your skills to make an impact** **Required… more
- AdventHealth (Orlando, FL)
- …Collaborates with Senior Medical Officers with contracted managed care payers regarding utilization review management activities and maintain a positive ... care providers). Works in close coordination with the processes of the Utilization Review Management staff for continual process improvement and reporting.… more
- Centene Corporation (Tallahassee, FL)
- …Interact with network practitioners to provide education on best practice models and utilization management processes + Interact with the Medical Director, or ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more