• National Utilization

    Humana (Tallahassee, FL)
    **Become a part of our caring community and help us put health first** The Utilization Management (UM) Director , Clinical Strategy and Practice for Medicaid ... of how organization capabilities interrelate across the function or segment. The Utilization Management (UM) Director , Clinical Strategy and Practice… more
    Humana (06/06/25)
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  • AVP, Utilization Review & Pharmacy

    Zurich NA (Tallahassee, FL)
    …+ Experience in development and implementation of cost containment programs + Case management , utilization review, catastrophic or disability experience + 5 or ... AVP, Utilization Review & Pharmacy 123092 Zurich Insurance is...recruiting and retaining team members. + Drive the performance management process by communicating job expectations, monitoring and evaluating… more
    Zurich NA (05/22/25)
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  • Hospital Reviewer/ Utilization Manager

    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 ... of resources, avoidable days/denials. Works in collaboration with Appeals Management /Medical Director in the appeals process. +...Florida. + 3 years minimum experience in discharge planning, utilization management , or case management .… more
    DOCTORS HEALTHCARE PLANS, INC. (05/30/25)
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  • RN Manager - Utilization Review

    Ascension Health (Pensacola, FL)
    …salary range at the time of the offer._ **Responsibilities** Manage effective utilization review processes, including management of patient statusing processes ... of utilization criteria, appeal and review process, and case management system documentation. + Conduct hiring, training, directing, development and evaluation… more
    Ascension Health (06/04/25)
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  • Utilization Review Clinician - Pacific…

    Monte Nido (Miami, FL)
    …while providing the opportunity for people to realize their healthy selves. ** Utilization Review Clinician** **Monte Nido** **Remote - Pacific hours** **Monte Nido ... to provide comprehensive care within an intimate home setting. The Utilization Review **Clinician** is responsible for conducting daily administrative and… more
    Monte Nido (06/05/25)
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  • Divisional Director of Care…

    CenterWell (Tallahassee, FL)
    …for managing populations and coordinating care to reduce acute and post-acute care utilization . The Divisional Director role is a hybrid with travel requirements ... solutions that will lead to acute and post-acute care utilization reductions aligned with the PCO's objectives and goals....impact** **Required Qualifications:** + **At least 5 years of Management experience required** ; _3-5 years of Director more
    CenterWell (05/23/25)
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  • Director Case Management

    HCA Healthcare (Kissimmee, FL)
    …a part of our team. **Job Summary and Qualifications** The Facility Case Management Director has the overall responsibility for managing and coordinating ... join an organization that invests in you as a(an) Director Case Management ? At HCA Florida Poinciana...to ensure continuity of care and optimal clinical resource utilization . The Director has oversight for all… more
    HCA Healthcare (06/06/25)
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  • Director Case Management

    HCA Healthcare (Gainesville, FL)
    …We want you to apply! **Job Summary and Qualifications** The Facility Case Management Director has the overall responsibility for managing and coordinating ... each individual is recognized. Submit your application for our Director Case Management opening with HCA Florida...to ensure continuity of care and optimal clinical resource utilization . The Director has oversight for all… more
    HCA Healthcare (04/09/25)
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  • Medical Director - Medicaid N. Central

    Humana (Tallahassee, FL)
    …to the Lead Medical Director - North Central Medicaid Markets. The Medical Director conducts Utilization Management of the care received by members in ... community and help us put health first** The Medical Director relies on medical background and reviews health claims....with prior experience participating in teams focusing on quality management , utilization management , case … more
    Humana (05/14/25)
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  • Part-time Pediatric / Family Medicine Medical…

    Centene Corporation (Tallahassee, FL)
    …must be a Florida resident. + Provides medical leadership of all for utilization management , cost containment, and medical quality improvement activities. + ... Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate,… more
    Centene Corporation (05/03/25)
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