- Humana (Tallahassee, FL)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent… more
- 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 ... in med surg or specialty area - Managed Care experience preferred, especially Utilization Management - Preference for those residing in ET zones **Education**… more
- CVS Health (Tallahassee, FL)
- …of clinical experience in acute or post-acute setting, and 1+ years of Utilization Management / Care Management Experience + Must have active current ... additional Nursing Licenses as business needs require. **Preferred Qualifications** Utilization Management experience preferred **Education** Education: Diploma… more
- CVS Health (Tallahassee, FL)
- … 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 to ... Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare… more
- Community Health Systems (Naples, FL)
- Join us as a **Registered Nurse (RN) - Utilization Review position** at Physicians Regional Collier Unit: Utilization Review Shift: Mon-Fri (this is an ... available for Full and Part-Time roles **Job Summary** The Utilization Review Nurse - RN reviews hospital...tools. + Collaborates with providers, care teams, and case management to ensure appropriate documentation, clinical justification,… more
- BayCare Health System (St. Petersburg, FL)
- …includes 3 years of Case Management or 3 years of Utilization Management or 6 years of clinical nursing **Certifications and Licensures:** + Required RN ... on a foundation of trust, dignity, respect, responsibility and clinical excellence. **The Team Lead Utilization Review...Bachelors in Nursing **Experience:** + Required 3 years in Utilization Management or + Required 3 years… more
- ERP International (Macdill AFB, FL)
- …is seeking a **Registered** ** Nurse (RN)** for a Full-Time position in ** Utilization Management ** at MacDill AFB, FL. Apply online today and discover more ... sectors. We provide comprehensive enterprise information technology, strategic sourcing, and management solutions to DoD and federal civilian agencies in 40 states.… more
- BayCare Health System (Tampa, FL)
- …built on a foundation of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior/RN responsibilities ... Occasional + **On Call:** No **Certifications and Licensures:** + Required RN (Registered Nurse ) + Preferred ACM (Case Management ) + Preferred CCM (Case Manager)… more
- Centene Corporation (Tallahassee, FL)
- …be the one who changes everything for our 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, ... Behavioral Analysis (ABA) services provided to determine medical appropriateness. Monitors clinical effectiveness and efficiency of member's care in accordance with… more
- Evolent (Tallahassee, FL)
- … Reviewer, Nurse , you will routinely interact with leadership and management staff, other CR's ( Clinical Reviewers), providers, office staff and Field ... culture. **What You'll Be Doing:** Job Description As a Clinical Reviewer, Nurse , you will be a..., you will be a key member of the utilization management team. We can offer you… more
- Centene Corporation (Tallahassee, FL)
- …findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and ... preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + LPN -… more
- Evolent (Tallahassee, FL)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
- Actalent (Orlando, FL)
- …Trucare Cloud preferred) + Knowledge of Medicaid or Medicare regulations and utilization management processes + Proficiency in Microsoft Word, Excel, and ... Clinical Review Nurse - Concurrent Review...systems + Medicaid, Medicare or insurance-related knowledge + Prior utilization management experience What We Offer +… more
- Fresenius Medical Center (Clermont, FL)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical ... or chronic kidney disease. **Training and advancement:** You will enter our Clinical Leadership Program that creates and supports a culture of continuous learning… more
- Elevance Health (Tampa, FL)
- **Medical Management Nurse ** **Location:** Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training ... **Must reside in the state of Florida** The **Medical Management Nurse ** will be responsible for review... experience and requires a minimum of 2 years clinical , utilization review, or managed care experience;… more
- Molina Healthcare (Tampa, FL)
- …recommendations for denial or modification of payment decisions. + Serves as a clinical resource for utilization management , CMOs, physicians and ... ensure appropriate reimbursement to providers. + Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS)… more
- Veterans Affairs, Veterans Health Administration (Bay Pines, FL)
- …promotion, health education and coaching on wellness, disease prevention, and chronic care management . The nurse will assist in directing the provision of ... responsibility for the coordination of care focused on patient education, self- management , and customer satisfaction throughout the continuum of care. Administers… more
- HCA Healthcare (Kissimmee, FL)
- …administrative oversight of the case management team. The Manager for Case Management functions as an expert clinical practitioner, case management ... manage in a new era as a Manager Case Management where building a healthier tomorrow is more than...supporting a balance of optimal care and appropriate resource utilization .** What qualifications you will need: + (RN) Registered… more
- Veterans Affairs, Veterans Health Administration (Bay Pines, FL)
- …Performs consults in inpatient acute care, CLC, and outpatient settings. Ongoing daily clinical management of Veterans receiving care in inpatient acute care, ... Summary The Advanced Practice Nurse III Certified Nurse Practitioner (NP)...the Veterans Affairs (VA) mission. The NP provides advanced clinical practice, consultation, and management . Assigned under… more