• Director of Utilization…

    Monte Nido (Miami, FL)
    …lives while providing the opportunity for people to realize their healthy selves. ** Director of Utilization Management** **Monte Nido** **Remote** Monte Nido has ... an intimate home setting. We are looking for a Director of Utilization Management to oversee the... of Utilization Management to oversee the Utilization Management/ Review team and function. This role… more
    Monte Nido (10/17/25)
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  • Behavioral Health Utilization Review…

    Actalent (Fort Lauderdale, FL)
    Actalent is Hiring a Behavioral Health Utilization Review Nurse Job Description We are seeking a dedicated Utilization Management Nurse (UMN) who will work ... cases, internal process development, and provide education to the team on utilization review -related issues. Responsibilities + Review prior authorization… more
    Actalent (10/15/25)
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  • Behavioral Health Utilization Review…

    Actalent (Sunrise, FL)
    Job Title: Behavioral Health Utilization Review NurseJob Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing requests for ... collaboration with the interdisciplinary team, the UMN handles tasks related to utilization review across various specialties, medical treatments, and services.… more
    Actalent (10/10/25)
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  • Clinical Registered Nurse - Utilization…

    Cognizant (Tallahassee, FL)
    …. Draft and submit the medical necessity determinations to the Health Plan/Medical Director based on the review of clinical documentation in accordance with ... as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral,...Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan .… more
    Cognizant (10/07/25)
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  • National Accounts Medical Director

    Elevance Health (Miami, FL)
    …members. The medical director provides clinical expertise in all aspects of utilization review and case management. Provides input on the clinical relevance ... Day to day clinical responsibilities means that the medical director is directly involved in Utilization Management...state or territory of the United States when conducting utilization review or an appeals consideration and… more
    Elevance Health (09/23/25)
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  • Pediatric & Family Medicine Medical…

    Centene Corporation (Tallahassee, FL)
    …management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , quality ... of physician education with respect to clinical issues and policies. + Identifies utilization review studies and evaluates adverse trends in utilization … more
    Centene Corporation (10/08/25)
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  • Field Medical Director , Interventional…

    Evolent (Tallahassee, FL)
    … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director...the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
    Evolent (07/30/25)
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  • Executive Director

    Sevita (FL)
    …status, citizenship, or any other characteristic protected by law._ **Executive Director of Operations** **Starting at $150,000 | Florida-Based Opportunity** Are you ... leader ready to make a meaningful impact? We're seeking a **dynamic Executive Director of Operations** to lead with strategy, vision, and results. + **Starting… more
    Sevita (09/09/25)
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  • Medical Director - Gulf South

    Humana (Tallahassee, FL)
    …understand how to operationalize this knowledge in their daily work. The Medical Director 's work includes computer based review of moderately complex to complex ... health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review … more
    Humana (10/03/25)
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  • Field Medical Director - Vascular Surgery

    Evolent (Tallahassee, FL)
    … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... training per inter-rater reliability process. + May assist the Senior Medical Director in research activities/questions related to the Utilization Management… more
    Evolent (10/10/25)
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