• Behavioral Health Utilization…

    Actalent (Sunrise, FL)
    Job Title: Behavioral Health Utilization Review NurseJob Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing ... department activities as assigned. Essential Skills + Experience in utilization management , behavioral health, and...+ Valid Florida Driver's License. + Knowledge of case management and utilization review concepts,… more
    Actalent (10/04/25)
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  • Medical Director, Behavioral Health (NE)

    Molina Healthcare (St. Petersburg, FL)
    …and clinical leadership for health plan and/or market specific utilization management and care management behavioral health programs and chemical ... dependency services - working closely with regional medical directors to standardize behavioral health utilization management policies and procedures to… more
    Molina Healthcare (10/03/25)
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  • Psychologist Reviewer

    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
    Centene Corporation (10/05/25)
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  • Psychologist Reviewer

    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
    Centene Corporation (08/08/25)
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  • Utilization Review Clinician…

    Centene Corporation (Tallahassee, FL)
    …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... appropriateness in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine overall… more
    Centene Corporation (10/01/25)
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  • Healthcare Services Operations Support Auditor

    Molina Healthcare (Miami, FL)
    …suite/applicable software program(s) proficiency. Preferred Qualifications * Utilization management , care management , behavioral health and/or long-term ... Job Duties * Performs audits of non-clinical staff in utilization management , care management , member...services and supports (LTSS) non-clinical review /auditing experience. To all current Molina employees: If you… more
    Molina Healthcare (10/09/25)
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  • Medical Director, Behavioral Health (TX/WA)

    Molina Healthcare (Tampa, FL)
    …Summary** Molina's Behavioral Health function provides leadership and guidance for utilization management and case management programs for mental health ... assists with implementing integrated Behavioral Health care management programs. **Knowledge/Skills/Abilities** Provides Psychiatric leadership for utilization… more
    Molina Healthcare (09/13/25)
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  • Behavioral Medical Director - Florida

    Centene Corporation (Tallahassee, FL)
    …functions for the business unit. + Provides medical leadership of all for utilization management , cost containment, and medical quality improvement activities. + ... Performs medical review activities pertaining to utilization review...expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory,… more
    Centene Corporation (09/04/25)
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  • Care Review Clinician, PA (RN)

    Molina Healthcare (Orlando, FL)
    …Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). MULTI STATE / COMPACT LICENSURE… more
    Molina Healthcare (09/05/25)
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  • Medical Director

    Centene Corporation (Tallahassee, FL)
    …functions for the business unit. + Provides medical leadership of all for utilization management , cost containment, and medical quality improvement activities. + ... Performs medical review activities pertaining to utilization review...expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory,… more
    Centene Corporation (10/03/25)
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