- CVS Health (Tallahassee, FL)
- …Must have active current and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and work schedules will include ... surg or specialty area - Managed Care experience preferred, especially Utilization Management - Preference for those residing in EST zones **Education**… more
- CVS Health (Tallahassee, FL)
- …years of clinical experience in acute or post-acute setting,and 1+ years of Utilization Management / CareManagementExperience + Must have active current and ... obtainadditionalNursing Licenses as business needsrequire. * **Preferred Qualifications** - Utilization Management experience preferred - **Anticipated Weekly… more
- CenterWell (Tallahassee, FL)
- …RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Humana (Tallahassee, FL)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Cognizant (Tallahassee, FL)
- …background - Registered Nurse (RN) + 2-3 years combined clinical and/or utilization management experience with managed health care plan + 3 years' experience ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations + Experience in utilization management to include Clinical Appeals and… more
- MyFlorida (Chattahoochee, FL)
- REGISTERED NURSE SPECIALIST - F/C - 67072411 APD/ DDDP CHATTAHOOCHEE, FL Date: Dec 9, 2025 The State Personnel System is an E-Verify employer. For more information ... Agency: Agency for Persons with Disabilities Working Title: REGISTERED NURSE SPECIALIST - F/C - 67072411 APD/ DDDP CHATTAHOOCHEE,...dynamics. This position with APD will serve staff and management across the Agency. Your work will impact the… more
- MyFlorida (Chattahoochee, FL)
- REGISTERED NURSE SPECIALIST - 60010620 Date: Dec 18, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... . Requisition No: 858611 Agency: Children and Families Working Title: REGISTERED NURSE SPECIALIST - 60010620 Pay Plan: Career Service Position Number: 60010620… more
- Evolent (Tallahassee, FL)
- …Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are performed ... medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the continuum… more
- HCA Healthcare (Tallahassee, FL)
- …**Introduction** Do you have the PRN career opportunities as an Operating Room Nurse PRN-Surgery Center you want with your current employer? We have an exciting ... Do you want to work as an Operating Room Nurse PRN-Surgery Center where your passion for creating positive...the instrument and equipment set-up for your OR, including utilization of preference cards and ability to anticipate your… more
- HCA Healthcare (Tallahassee, FL)
- …passionate about delivering patient-centered care?** Submit your application for Operating Room Nurse - Surgery Center position and spend more time at the bedside ... to deliver clinical excellence behind the scenes in data science, case management or transfer centers. Unlock your potential at Tallahassee Outpatient Surgery… more
- MTC (Quincy, FL)
- …record or other forms as appropriate. + Practice basic cost containment and utilization management for inmate care and facility operations. + Maintain absolute ... of Florida with an acceptable driving record required, unless waived by management . Management & Training Corporation (MTC) is an Equal Opportunity Employer. All… more
- HCA Healthcare (Tallahassee, FL)
- **Description** **Introduction** Do you have the career opportunities as a(an) Manager Case Management you want in your current role? We invest in what matters most ... meet these needs. + Develops, initiates, and coordinates individual patient case management plans to ensure appropriate level of care across the continuum. Ensures… more
- HCA Healthcare (Tallahassee, FL)
- …to Patient in Bed by facility by floor to identify opportunities + Assesses utilization of Bed Management technology for optimal use + Performs staffing ... that invests in you as a(an) Director PI Bed Management ? At HCA Healthcare, you come first. HCA Healthcare...for the implementation of process improvement ideas. + Educates nurse supervisors, unit secretaries, unit directors, and other staff… more
- Adecco US, Inc. (Tallahassee, FL)
- …its Case Management team. This role focuses on care coordination, utilization management , patient throughput, and discharge planning across the continuum of ... and patient status for medical necessity using approved criteria + Perform utilization management reviews and communicate findings to third-party payors +… more
- HCA Healthcare (Tallahassee, FL)
- …and assess observation patients for appropriateness in observation status + Performs utilization management reviews and communicates information to third party ... location._** It is an exciting time to be a nurse at HCA Healthcare! Come unlock your career potential...position if current and compliant** + **Certification in Case Management , Nursing, or Utilization Review, preferred** +… more
- HCA Healthcare (Tallahassee, FL)
- …and assess observation patients for appropriateness in observation status + Performs utilization management reviews and communicates information to third party ... required within90 days of hire** + **Advanced Practice Registered Nurse license is acceptable for position if current and...position if current and compliant** + **Certification in Case Management , Nursing, or Utilization Review, preferred** +… more
- HCA Healthcare (Tallahassee, FL)
- …and assess observation patients for appropriateness in observation status + Performs utilization management reviews and communicates information to third party ... within 90 days of hire** + **Advanced Practice Registered Nurse license is acceptable for position if current and...position if current and compliant** + **Certification in Case Management , Nursing, or Utilization Review, preferred** +… more
- CenterWell (Bainbridge, GA)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and conducts ... problems, identifies and evaluates alternative courses of action through the utilization of Performance Improvement principles. + Responsible for review of the… more
- Sharecare (Tallahassee, FL)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- Highmark Health (Tallahassee, FL)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... itemized bills, and claims data to assure appropriate level of payment and resource utilization . It is also used to identify issues which can be used for education… more