• 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 (07/18/25)
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  • Utilization Review Clinician…

    Monte Nido (Miami, FL)
    …save lives while providing the opportunity for people to realize their healthy selves. ** Utilization Review Clinician ** **Monte Nido** **Remote - EST or CST ... clinical strategies to provide comprehensive care within an intimate home setting. The Utilization Review ** Clinician ** is responsible for conducting daily… more
    Monte Nido (06/21/25)
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  • Care Review Clinician , PA (RN)

    Molina Healthcare (Tampa, FL)
    …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS… more
    Molina Healthcare (07/17/25)
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  • Care Review Clinician , Inpatient…

    Molina Healthcare (St. Petersburg, FL)
    …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. HCS… more
    Molina Healthcare (06/20/25)
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  • Care Review Clinician , PA (RN)…

    Molina Healthcare (Tampa, FL)
    …Experience Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS… more
    Molina Healthcare (07/17/25)
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  • Care Review Clinician , Inpatient…

    Molina Healthcare (Miami, FL)
    …plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members with high need potential. HCS ... or ER unit. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). To all current Molina employees: If… more
    Molina Healthcare (06/29/25)
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  • Associate Medical Director

    CenterWell (Jacksonville, FL)
    …clinical performance in patient experience, quality of care, clinical outcomes, and avoidable utilization + Periodically review clinician charts to identify ... of health (SDOH) efforts, improving clinical outcomes and avoidable utilization + Monitor and manage daily patient care and...and monitor clinical & financial performance and metrics. + Review clinician schedules and incentive plans to… more
    CenterWell (07/22/25)
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  • Associate Medical Director

    CenterWell (Daytona Beach, FL)
    …performance in patient experience, quality of care, clinical outcomes, and avoidable utilization *Periodically review clinician charts to identify ... and operational budgeting, and monitor clinical & financial performance and metrics. * Review clinician schedules and incentive plans to align with patient… more
    CenterWell (06/12/25)
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