- Actalent (Orlando, FL)
- Clinical Review Nurse - Concurrent Review Location: Remote - Candidates can be live anywhere in the US but must be able to work CST hours Schedules ... - 6:30 PM CST Position Overview We are seeking Clinical Review Nurses to join our remote...our remote team. In this role, you will perform concurrent reviews to evaluate medical necessity, determine appropriate levels… more
- Centene Corporation (Tallahassee, FL)
- …including a fresh perspective on workplace flexibility. Centene is hiring a **Remote Concurrent Review Nurse ** to support our **Florida Medicaid** line ... changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene...nursing license** (or compact license valid in FL). + ** Concurrent review experience** in a managed care… more
- Community Health Systems (Naples, FL)
- …and accurate clinical documentation. Under the direction of the Utilization Review leadership, this role supports concurrent review processes, ... match & more available for Full and Part-Time roles **Job Summary** The Utilization Review Nurse - RN reviews hospital admissions, extended stays, and supporting… more
- BayCare Health System (Tampa, FL)
- …other related parties to ensure appropriate level of care through comprehensive concurrent review for medical necessity of outpatient observation and inpatient ... built on a foundation of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior/RN responsibilities… more
- BayCare Health System (St. Petersburg, FL)
- …that's built on a foundation of trust, dignity, respect, responsibility and clinical excellence. **The Team Lead Utilization Review responsibilities include:** + ... the daily operations of the UM department responsible for concurrent reviews and observation management + Ensuring that the...**Position** Utilization Review Team Lead **Location** St Petersburg:St Anthonys | Clinical | Full Time **Req ID**… more
- BrightSpring Health Services (Gainesville, FL)
- …for assisting the Director of Nursing with the daily performance of clinical personnel by ensuring proper care is delivered to patients/clients. Serves as ... monitors both skilled and non-skilled healthcare services + Directly supervises clinical personnel + Provides clinical teaching and conducts performance… more
- HealthTrust Workforce Solutions (Bradenton, FL)
- …to assure that the following functions of the role are completed: Utilization Review for medical necessity of admission and concurrent stay, Social Services ... Interim Leader of Case Management Services is a Registered Nurse who participates as an active administrative member of...Intervention, Discharge Planning, Resource Management, Concurrent Analysis, Delay in Services and Quality Concerns. The… more
- Oracle (Tallahassee, FL)
- …(ECD) alignments, Critical Care workflow implementation, Multi-Disciplinary Rounding, and various nurse chart review and documentation optimizations. The ideal ... of analysts providing support for operationally required changes and enhancements to clinical applications, and aa group of analysts leading projects that will… more
- HCA Healthcare (Tallahassee, FL)
- …and accountability in ensuring all admissions and continued stays meet clinical criteria for appropriateness and medical necessity. Assesses discharge planning needs ... level of care across the continuum. Ensures plan meets patient's clinical , psychological and discharge needs in collaboration with the attending physician… more
- Molina Healthcare (Jacksonville, FL)
- …requests in timely support of nurse reviewers, reviews cases requiring concurrent review and manages the denial process. * Monitors appropriate care ... for national committee for quality assurance (NCQA) and utilization review accreditation commission (URAC) certifications. * Provides leadership and consultation… more
- Elevance Health (Miami, FL)
- …+ Requires HS diploma or equivalent, and a minimum of 2 years of clinical experience and/or utilization review experience. + Current active, valid and ... ensuring appropriate, consistent administration of plan benefits by reviewing clinical information and assessing medical necessity under relevant guidelines and/or… more
- BrightSpring Health Services (Clearwater, FL)
- …Registered Professional Nurse + Excellent communicator with ability to handle concurrent tasks and responsibilities + Ability to travel within assigned area + ... monitoring both skilled and non-skilled healthcare services + Directly supervises clinical personnel + Providing clinical teaching and conducting performance… more
- HCA Healthcare (Trinity, FL)
- …staff and board members on analysis of risk assessment, historical and concurrent occurrence and claims data and national trends. .You will ensure responsibility ... field required; Master's Degree preferred .Current Florida licensure as a Registered Nurse preferred _**If serving as facility's primary Risk Manager, VP must have… more