• RN Care Manager

    AdventHealth (Deland, FL)
    …qualifications: + BSN + Health-related Master's degree or MSN + Prior Care Management/ Utilization Management experience ACM/CCM Certification This facility ... of the implementation of the transitions of care plans prior to the discharge of the patient. The RN...physicians and the interdisciplinary team on issues related to utilization of resources, medical necessity, CMS CoP for Discharge… more
    AdventHealth (07/09/25)
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  • Manager I Medical Management ( Prior…

    Elevance Health (Tampa, FL)
    **Manager I Medical Management ( Prior Authorizations) - Florida Medicare** **Office Locations:** This role is based in Florida at either our Tampa or Miami ... as required by law._ The **Manager I Medical Management ( Prior Authorizations)** is responsible for managing a team of...RN license is strongly preferred. + 5+ years of utilization management experience strongly desired. + Exposure to Overpayment… more
    Elevance Health (07/25/25)
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  • Medical Director Physician Advisor UM

    AdventHealth (Altamonte Springs, FL)
    …role you will contribute:** The Physician Advisor provides primary support for Utilization Management (UM) and secondary support for Care Management (CM) departments ... responsible for educating, informing and advising members of the Utilization Management, Care Management, Managed Care and Revenue Cycle...2 or greater experience as a Physician Advisor + Prior experience with third party payors + CHCQM -… more
    AdventHealth (08/01/25)
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  • Supervisor, Care Review (RN)

    Molina Healthcare (FL)
    …an integrated Care Access and Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/ utilization review, and/or other ... clinical and non-clinical team activities to facilitate integrated, proactive utilization management, ensuring compliance with regulatory and accrediting standards.… more
    Molina Healthcare (07/27/25)
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  • Field Medical Director, Interventional Cardiology…

    Evolent (Tallahassee, FL)
    …the mission. Stay for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to make a ... meaningful impact on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director, Cardiovascular Specialist and use your… more
    Evolent (07/30/25)
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  • Group Manager - Operations Excellence

    Amentum (Kennedy Space Center, FL)
    …Asset Management principles and continuous improvements through best practices and utilization of Maximo, provide data base administration, software enhancements and ... testing, training, and implementation of major software upgrades. + COMET Facility Utilization Management (DFUM) group that assess space utilization requests,… more
    Amentum (07/12/25)
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  • Physician (Mental Health) - Associate Chief…

    Veterans Affairs, Veterans Health Administration (Miami, FL)
    …goals for eligibility, referral and authorization, care coordination, and utilization management to ensure improved Veteran experience. Makes recommendations for ... improving the Veteran's experience and outcomes. Defines mental health policies, utilization management process and procedures, financial and utilization reports… more
    Veterans Affairs, Veterans Health Administration (06/28/25)
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  • PGD Business Services Manager - Commercial O&M…

    NextEra Energy (Palm Beach Gardens, FL)
    …in finance, Engineering, Business Management and/or CFA + Significant analytical skillset, including utilization of BI and reporting tools + Prior experience in ... managing contracts, asset management, and customer relations + Able to solve complex problems + Excellent written and verbal communication skills with ability to build relationships + Strong influencing and interpersonal skills + High level of commercial… more
    NextEra Energy (05/30/25)
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  • Senior Pharmacist

    Highmark Health (Tallahassee, FL)
    …of utilization management programs including but not limited to: prior authorization, dose and duration edits, quantity limits, step-care edits, generic sampling ... RESPONSIBILITIES** + Monitor FDA-approvals, drug manufacturer pipelines, assess drug utilization reports, and write drug monographs for Committee review to… more
    Highmark Health (06/26/25)
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  • Mission Control RN Tier1 Transfer Center FT Days

    AdventHealth (Orlando, FL)
    …to the transfer and placement of all patients. Proactively initiates steps, including utilization of the hospital and physician chain of command, to prevent EMTALA ... census for placement opportunities. Ensures legal documentation is accurate and appropriate prior to transfer of patients. Acts as a liaison between patients,… more
    AdventHealth (07/31/25)
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