- 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
- 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
- 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
- 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
- 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
- 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
- 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 (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
- 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
- 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
- Evolent (Tallahassee, FL)
- …classes as needed for new hires to educate and train on Utilization management system and Field Medical Director process, standards and resources. + Acts as ... for the culture. **What You'll Be Doing:** The Medical Director for MSK Surgery is a key member of...reviews appeal cases and/or attends hearings for discussion of utilization management decisions. + Strong partnership with… more
- Humana (Tallahassee, FL)
- … Director , depending on size of region or line of business. 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
- Evolent (Tallahassee, FL)
- …impact on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your ... Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
- Humana (Tallahassee, FL)
- … Director , depending on size of region or line of business. 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
- Molina Healthcare (FL)
- … and effective resource management . + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure ... IT and data analysts to produce tools to report, monitor and improve Utilization Management . + Actively participates in regulatory, professional and community… more
- Humana (Tallahassee, FL)
- …Medical Director , depending on size of team or line of business. 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 fundamentals of CMS Medicare Guidance on...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Evolent (Tallahassee, FL)
- …Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + ... 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
- Evolent (Tallahassee, FL)
- …Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + ... 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
- AdventHealth (Apopka, FL)
- …**Location:** 5050 Wesley Rd Apopka, FL 32712 **The role you'll contribute:** **The Director of Inventory Management is responsible for providing leadership and ... key in mitigating organizational exposure to product supply and distribution disruption. The Director of Inventory Management will also be responsible for a team… more
- United Therapeutics (Tallahassee, FL)
- …is innovative and inspiring where you can truly make a difference. The Regional Field Director , RNS Program Management serves as a director of all clinical ... the commercial non-promotional team. In addition, the Regional Field Director , RNS Program Management will: + Serve...initiation of a UT product, adverse effect mitigation, device utilization , and dosing upon request + Support the Clinical… more