- Humana (Tallahassee, FL)
- …and help us put health first** Humana Healthy Horizons in Ohio is seeking a Utilization Management Nurse 2 who utilizes clinical nursing skills to support ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Cleveland Clinic (Weston, FL)
- …stay or visit. Some of the responsibilities of a Utilization Management Specialist include medical record review , providing clinical information to payers, ... Utilization Management Specialist Join Cleveland Clinic... (UM) Specialists perform UM activities, such as admission review , concurrent review , retrospective chart review… more
- BayCare Health System (Clearwater, FL)
- …2 years in Utilization Review or + Required 2 years in Case Management or + Required 3 years Registered Nurse + Preferred experience in Critical Care or ... foundation of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior responsibilities include:** + Functions… more
- Centene Corporation (Tallahassee, FL)
- …assess ABA Treatment Plans preferred. + Knowledge of ABA services and BH utilization review process preferred. + Experience working with providers and healthcare ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- Centene Corporation (Tallahassee, FL)
- … utilization management team. + Monitors behavioral health (BH) utilization review clinicians and ensures compliance with applicable guidelines + Monitors ... in the State of Florida **Position Purpose:** Supervises the behavioral health (BH) utilization review clinicians to ensure appropriate care for members and… more
- AdventHealth (Daytona Beach, FL)
- …Medical Parkway, Daytona Beach, FL 32117 **The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use clinical ... reviews within 24 hours of admission; and when warranted by length of stay, utilization review plan, and/or best practice guidelines, on a continuing basis. +… more
- AmeriHealth Caritas (Palm Beach Gardens, FL)
- …or post acute care (SNF/rehab/LTAC) experience required. + 1+ years of Utilization Management experience desired, preferably in a Managed Care Organization. ... it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other… more
- Molina Healthcare (Jacksonville, FL)
- …of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. ... SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years… more
- ChenMed (Tampa, FL)
- …of care and cost effectiveness through the integrating and functions of case management , utilization review and discharge planning. The incumbent in ... assist in achieving desired clinical outcomes within specific timeframe. + Conducts review for appropriate utilization of services from admission through… more
- AdventHealth (Altamonte Springs, FL)
- …Nursing OR Social Worker: BSW Two (2) years of experience in direct Care Management State specific RN license if a nurse **Preferred qualifications:** Registered ... and 125,000 outpatients each year **The role you'll contribute:** **The Care Management Supervisor is under the general leadership of the Care Management… more
- Community Health Systems (Milton, FL)
- …efficiency and overall effectiveness. + Oversight and evaluation of the discharge planner/ utilization review nurse . + Perform and oversee needs analysis ... RN License-active + Case Management experience 2+ years + Utilization review experience 2+ years + Knowledgeable of resident's financial status, diagnosis… more
- MyFlorida (Land O' Lakes, FL)
- SENIOR LICENSED PRACTICAL NURSE - 50000082 Date: Dec 30, 2024 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... Requisition No: 843801 Agency: Veterans Affairs Working Title: SENIOR LICENSED PRACTICAL NURSE - 50000082 Pay Plan: Career Service Position Number: 50000082 Salary:… more
- MyFlorida (Port Charlotte, FL)
- SENIOR REGISTERED NURSE SUPV - 50009026 Date: Jan 10, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... No: 844535 Agency: Veterans Affairs Working Title: SENIOR REGISTERED NURSE SUPV - 50009026 Pay Plan: Career Service Position...that the residents are receiving total nursing care. + Review shift assignments and ensure that the assignments reflect… more
- MyFlorida (Orlando, FL)
- REGISTERED NURSE Date: Jan 22, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... . Requisition No: 845312 Agency: Veterans Affairs Working Title: REGISTERED NURSE Pay Plan: Career Service Position Number: 50009834 Salary: $66,414.40 Posting… more
- Veterans Affairs, Veterans Health Administration (West Palm Beach, FL)
- …with members of the interdisciplinary team. Responsibilities The (CLC) Registered Nurse (RN) is responsible and accountable for individual nursing practice and ... determines the appropriate delegation of tasks consistent with the nurse 's obligation to provide optimal care. The focus is...Set (MDS) Coordinator to ensure accuracy of the Resource Utilization Group (RUG) score. VA offers a comprehensive total… more
- MyFlorida (Daytona Beach, FL)
- REGISTERED NURSE - 50009836 Date: Jan 9, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... . Requisition No: 844226 Agency: Veterans Affairs Working Title: REGISTERED NURSE - 50009836 Pay Plan: Career Service Position Number: 50009836 Salary:… more
- Matrix Providers (Jacksonville, FL)
- …TRICARE directives, coordinating with the local Medical Home Port (MHP) clinic, utilization and Referral Management policies, and obtains additional clinical ... Licensed Practical Nurse (LPN/LVN) -Naval Hospital Jacksonville, FL Location: Jacksonville,...Consult, coordinate, and collaborate with MHP team members, referral management team members, specialty care clinics, outside care professionals,… more
- MyFlorida (Panama City Beach, FL)
- OPS REGISTERED NURSE - 50601527 Date: Jan 15, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... No: 843089 Agency: Veterans Affairs Working Title: OPS REGISTERED NURSE - 50601527 Pay Plan: Health Care Practice Position...and procedures + Monitor physician's orders for completion + Review and follow-up on resident incidents or complaints +… more
- AdventHealth (Orlando, FL)
- …documents avoidable days, and facilitates progression of care. Collaborates with Utilization Management staff for collaboration on patient status changes ... (as permitted by the patient) as well as a review of the current and past inpatient and outpatient...+ Health-related Master's degree or MSN + Prior Care Management / Utilization Management experience **KNOWLEDGE AND… more
- Humana (Fort Lauderdale, FL)
- …Previous Medicare/Medicaid experience a plus. + Previous experience in prior authorization, utilization management + Experience working with MCG or Interqual ... goal to put health first? The Prior Authorization, Registered Nurse , RN, Intern will review prior authorization... depending on case findings. + Educates providers on utilization and medical management processes. + Enters… more