Jacksonville, FL · On-site
$186K - $363K/yr
... directors to standardize behavioral health utilization management policies and procedures to ... Standardizes behavioral health-related utilization management, quality, and financial goals across ...
Jacksonville, FL · On-site
$186K - $363K/yr
... directors to standardize behavioral health utilization management policies and procedures to ... Standardizes behavioral health-related utilization management, quality, and financial goals across ...
Orlando, FL · On-site
$186K - $363K/yr
... directors to standardize behavioral health utilization management policies and procedures to ... Standardizes behavioral health-related utilization management, quality, and financial goals across ...
Orlando, FL · On-site
$186K - $363K/yr
... directors to standardize behavioral health utilization management policies and procedures to ... Standardizes behavioral health-related utilization management, quality, and financial goals across ...
Jacksonville, FL · On-site
$150 - $200/hr
Vice President of Product, Medical Cost Containment & Authorization** to lead the strategy, execution, and scale of our Utilization Management (UM) product portfolio during a pivotal moment of ...
Jacksonville, FL · On-site
$150 - $200/hr
Vice President of Product, Medical Cost Containment & Authorization** to lead the strategy, execution, and scale of our Utilization Management (UM) product portfolio during a pivotal moment of ...
As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical ...
As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical ...
Lee Health is seeking a System Medical Director of Physician Advisors! Lee Health is a nonprofit ... Provide physician leadership and strategic oversight for utilization management, care coordination ...
Lee Health is seeking a System Medical Director of Physician Advisors! Lee Health is a nonprofit ... Provide physician leadership and strategic oversight for utilization management, care coordination ...
Lee Health is seeking a System Medical Director of Physician Advisors! Lee Health is a nonprofit ... Provide physician leadership and strategic oversight for utilization management, care coordination ...
Lee Health is seeking a System Medical Director of Physician Advisors! Lee Health is a nonprofit ... Provide physician leadership and strategic oversight for utilization management, care coordination ...
Miami, FL · On-site
We are seeking a Medical Director to join our team at Independent Living Systems (ILS). ILS, along ... Serve as a clinical leader in the performance of utilization management and quality of care ...
Quick apply
Miami, FL · On-site
We are seeking a Medical Director to join our team at Independent Living Systems (ILS). ILS, along ... Serve as a clinical leader in the performance of utilization management and quality of care ...
Jacksonville, FL · On-site
Utilization Management * Home Health * Hospital at Home * Transition of Care team * Integrate the mission, vision, and values of UF Health Jacksonville across all Post-Acute Care Services. * Provide ...
Jacksonville, FL · On-site
Utilization Management * Home Health * Hospital at Home * Transition of Care team * Integrate the mission, vision, and values of UF Health Jacksonville across all Post-Acute Care Services. * Provide ...
Jacksonville, FL · On-site
Utilization Management * Home Health * Hospital at Home * Transition of Care team * Integrate the mission, vision, and values of UF Health Jacksonville across all Post-Acute Care Services. * Provide ...
Jacksonville, FL · On-site
Utilization Management * Home Health * Hospital at Home * Transition of Care team * Integrate the mission, vision, and values of UF Health Jacksonville across all Post-Acute Care Services. * Provide ...
As the Director of Case Management , you will use your clinical knowledge and contribute to the ... Utilization Review (UR) and resource management, discharge planning, treatment plan management and ...
As the Director of Case Management , you will use your clinical knowledge and contribute to the ... Utilization Review (UR) and resource management, discharge planning, treatment plan management and ...
Tampa, FL · On-site
$93K/yr
Strong knowledge of utilization management and appeals processes. * In-depth understanding of NCQA ... Ensure the team effectively prepares comprehensive case reviews for Medical Directors by:
Tampa, FL · On-site
$93K/yr
Strong knowledge of utilization management and appeals processes. * In-depth understanding of NCQA ... Ensure the team effectively prepares comprehensive case reviews for Medical Directors by:
Tampa, FL · Remote
$93K/yr
Strong knowledge of utilization management and appeals processes. * In-depth understanding of NCQA ... Ensure the team effectively prepares comprehensive case reviews for Medical Directors by:
Tampa, FL · Remote
$93K/yr
Strong knowledge of utilization management and appeals processes. * In-depth understanding of NCQA ... Ensure the team effectively prepares comprehensive case reviews for Medical Directors by:
... revenue cycle management while focusing on delivering exceptional patient care. Our team is ... Senior RCM Director Supervisory Responsibilities: None. JOB DUTIES: * Completes Initial, concurrent ...
... revenue cycle management while focusing on delivering exceptional patient care. Our team is ... Senior RCM Director Supervisory Responsibilities: None. JOB DUTIES: * Completes Initial, concurrent ...
Tampa, FL · Remote
$93K/yr
Strong knowledge of utilization management and appeals processes. * In-depth understanding of NCQA ... Ensure the team effectively prepares comprehensive case reviews for Medical Directors by:
Tampa, FL · Remote
$93K/yr
Strong knowledge of utilization management and appeals processes. * In-depth understanding of NCQA ... Ensure the team effectively prepares comprehensive case reviews for Medical Directors by:
Orlando, FL · On-site
Director of Prior Authorization EmpiRx Health is the leading clinically-driven pharmacy benefits ... Strong understanding of utilization management, formulary compliance, and appeals processing.
Quick apply
Orlando, FL · On-site
Director of Prior Authorization EmpiRx Health is the leading clinically-driven pharmacy benefits ... Strong understanding of utilization management, formulary compliance, and appeals processing.
Miami, FL · On-site
Works with the Utilization Management team primarily responsible for inpatient medical necessity ... Consults with and refers cases to medical directors regularly, as necessary. Complies with required ...
Miami, FL · On-site
Works with the Utilization Management team primarily responsible for inpatient medical necessity ... Consults with and refers cases to medical directors regularly, as necessary. Complies with required ...
A great group in Jacksonville, FL is seeking an experienced part-time Medical Director (Board ... Basic job responsibilities include: medical leadership for utilization management, cost containment ...
A great group in Jacksonville, FL is seeking an experienced part-time Medical Director (Board ... Basic job responsibilities include: medical leadership for utilization management, cost containment ...
... directors of third-party payers to discuss the medical necessity, utilization of resources and appropriate level of care. DUTIES AND RESPONSIBILITIES: Utilization Management Functions * Reviews ...
... directors of third-party payers to discuss the medical necessity, utilization of resources and appropriate level of care. DUTIES AND RESPONSIBILITIES: Utilization Management Functions * Reviews ...
Tallahassee, FL · On-site
$130 - $140/hr
As a Vascular Surgery, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients' lives, in a non-clinical ...
Tallahassee, FL · On-site
$130 - $140/hr
As a Vascular Surgery, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients' lives, in a non-clinical ...
... directors of third-party payers to discuss the medical necessity, utilization of resources and appropriate level of care. DUTIES AND RESPONSIBILITIES: Utilization Management Functions * Reviews ...
Quick apply
... directors of third-party payers to discuss the medical necessity, utilization of resources and appropriate level of care. DUTIES AND RESPONSIBILITIES: Utilization Management Functions * Reviews ...
$13.5K - $17.9K
1% of jobs
$17.9K - $22.4K
3% of jobs
$22.4K - $26.9K
11% of jobs
$29.8K is the 25th percentile. Wages below this are outliers.
$26.9K - $31.4K
16% of jobs
$31.4K - $35.9K
15% of jobs
The median wage is $37.2K / yr.
$35.9K - $40.4K
16% of jobs
$44.1K is the 75th percentile. Wages above this are outliers.
$40.4K - $44.8K
17% of jobs
$44.8K - $49.3K
9% of jobs
$49.3K - $53.8K
7% of jobs
$53.8K - $58.3K
3% of jobs
$58.3K - $62.8K
2% of jobs
$13.5K
$39.1K
$62.8K
A Director of Utilization Management oversees the review and approval of medical services to ensure they are necessary, efficient, and cost-effective. They develop strategies to improve care quality while managing healthcare costs, working closely with providers, payers, and regulatory bodies. Their responsibilities include policy development, compliance with healthcare regulations, and leading a team of utilization review professionals. This role is common in hospitals, insurance companies, and managed care organizations.
A Director Utilization Management generally oversees a team responsible for reviewing patient care to ensure appropriate resource use and compliance with payer requirements. Daily tasks may include analyzing utilization data, developing policy and process improvements, collaborating with clinical and administrative staff, and addressing escalated cases or issues. Directors frequently attend strategy meetings, conduct staff training, and engage with external partners like insurance providers. This role requires balancing administrative oversight with hands-on problem solving to support both cost efficiency and quality patient care.
To thrive as a Director Utilization Management, you need a strong background in healthcare administration, case management, and data-driven decision-making, often supported by a clinical degree and several years of management experience. Familiarity with utilization management software, electronic health records (EHRs), and certifications such as CCM or ACM are typically valued. Exceptional leadership, communication, and problem-solving skills distinguish top performers in this role. These competencies are vital for optimizing resource use, ensuring regulatory compliance, and leading teams to meet quality care standards.
The most popular types of Utilization Management jobs in Florida are:
For Director Utilization Management jobs in Florida, the most frequently searched job titles are:
The top searched job categories for Director Utilization Management jobs in Florida are:
Cities in Florida with the most Director Utilization Management job openings:
$186K - $363K/yr
Full-time
Re-posted 21 days ago
8.0
Based on 199 frontline employees who took The Breakroom Quiz
170th of 315 rated insurance
JOB DESCRIPTION Job SummaryProvides medical oversight and expertise related to behavioral health and chemical dependency services, and assists with implementation of integrated behavioral health care programs within specific markets/regions. Contributes to overarching strategy to provide quality and cost-effective member care.
Based in Nevada
Essential Job Duties
Provides behavioral health oversight and clinical leadership for health plan and/or market specific utilization management and care management behavioral health programs and chemical dependency services - working closely with regional medical directors to standardize behavioral health utilization management policies and procedures to improve quality outcomes and decrease costs.
Facilitates behavioral health-related regional medical necessity reviews and cross coverage.
Standardizes behavioral health-related utilization management, quality, and financial goals across all lines of businesses.
Responds to behavioral health-related requests for proposal (RFP) sections and reviews behavioral health portions of state contracts.
Assists behavioral health medical director lead trainers in the development of enterprise-wide education on psychiatric diagnoses and treatment.
Provides second level behavioral health clinical reviews, peer reviews and appeals.
Supports behavioral health committees for quality compliance.
Implements behavioral health specific clinical practice guidelines and medical necessity review criteria.
Tracks all clinical programs for behavioral health quality compliance with National Committee for Quality Assurance (NCQA) and Centers for Medicare and Medicaid Services (CMS).
Assists with the recruitment and orientation of new psychiatric medical directors.
Ensures all behavioral health programs and policies are in line with industry standards and best practices.
Assists with new program implementation and supports for health plan in-source behavioral health services.
Required Qualifications
At least 3 of relevant experience, including 2 years of medical practice experience in psychiatry/behavioral health, or equivalent combination of relevant education and experience.
Doctor of Medicine (MD) or Doctor of Osteopathy (DO). License must be active and unrestricted in state of practice.
Board Certification in Psychiatry.
Working knowledge of applicable national, state, and local laws and regulatory requirements affecting medical and clinical staff.
Ability to work cross-collaboratively within a highly matrixed organization.
Strong organizational and time-management skills.
Ability to multi-task and meet deadlines.
Attention to detail.
Critical-thinking and active listening skills.
Decision-making and problem-solving skills.
Strong verbal and written communication skills.
Microsoft Office suite/applicable software program(s) proficiency, and ability to learn new programs.
Preferred Qualifications
Experience with utilization/quality program management.
Managed care experience.
Peer review experience.
Certified Professional in Healthcare Management (CPHM), Certified Professional in Health Care Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of America (CMSA) or other health care or management certification.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $186,201.39 - $363,093 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.
Health care and social assistance
10,000+ Employees
Long Beach, CA, US
1980
