- Humana (Tallahassee, FL)
- …Degree or BSN degree. + Minimum 3 years of experience in NCQA Health Plan Accreditation and/or Utilization Management + Exceptional attention to detail. + ... help us put health first** We are seeking a Senior Accreditation Professional who will work in...on NCQA accreditation standards, especially related to Utilization Management and/or Behavioral Health; MED-Deeming … more
- Centene Corporation (Tallahassee, FL)
- …best practices related to BH utilization management + Works with BH utilization management team and senior management to identify opportunities ... **We're looking for two remote Supervisors of Behavioral Health Utilization Management to support our Florida market....team, members, and providers + Works with the BH senior management to develop and implement UM… more
- MyFlorida (Chattahoochee, FL)
- SENIOR HUMAN SERVIC COUNSELOR SUPV - SES - 60005161 Date: May 6, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify ... Requisition No: 852115 Agency: Children and Families Working Title: SENIOR HUMAN SERVIC COUNSELOR SUPV - SES - 60005161...knowledgeable of and utilize the principles of Total Quality Management . The employee in this position is responsible for… more
- Evolent (Tallahassee, FL)
- …selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director. ... , you will be a key member of the utilization management team. We can offer you... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Humana (Tallahassee, FL)
- …a part of our caring community and help us put health first** The Senior Utilization Management Behavioral Health Professional utilizes behavioral health ... and communication of medical services and/or benefit administration determinations. The Senior Utilization Management Behavioral Health Professional work… more
- Evolent (Tallahassee, FL)
- …selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director. ... the mission. Stay for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to… more
- HCA Healthcare (Tallahassee, FL)
- …+ Assembles regional physician advisory panels to provide ongoing feedback to HCA senior management , and serves as a liaison between committees and ... review/ management . + Consults with facility-level staff regarding delegated utilization management and disease management operations under managed… more
- Evolent (Tallahassee, FL)
- …Doing:** Job Description As a FMD, Radiology you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
- Evolent (Tallahassee, FL)
- …members and providers + Appropriately identifies and refers quality issues to the Senior Director of Medical Management or Medical Director. + Appropriately ... policies + Creates adverse determination notifications that meet all accreditation , State, and Federal criteria + Uses Plain Language...identifies potential cases for Care Management programs + Communicates appropriate information to other staff… more