- Humana (Tallahassee, FL)
- …documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are ... a part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to support the… more
- Conviva (Tallahassee, FL)
- …+ Prior clinical experience, managed care experience, Home Health, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Orthopedic procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare… more
- Lincoln Financial Group (Tallahassee, FL)
- …and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management preferred skills ... Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible for… more
- Elevance Health (Tallahassee, FL)
- ** Utilization Management Representative II** **Location:** Must live within 50 miles of Costa Mesa, CA or a Florida PulsePoint. The ** Utilization ... + Master's degree preferred. Certain contracts require a Master's degree. + Utilization Management experience preferred. + Medical experience preferred, + Long… more
- Elevance Health (Tallahassee, FL)
- ** Utilization Management Representative II** **Location:** Must live within 50 miles of a Florida PulsePoint. The ** Utilization Management Representative ... given. + Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care. +...eligibility information. + May act as liaison between Medical Management and internal departments. Responds to telephone and written… more
- CVS Health (Tallahassee, FL)
- …service like Targeted Care Management , Psychosocial Rehabilitation, or related utilization management experience with these services . Must have active ... (LMSW, LCSW, LISW, LPC, or comparable) OR active and unrestricted Registered Nurse licensure with psychiatric specialty/certification in state of residence . Must be… more
- Centene Corporation (Tallahassee, FL)
- …28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive ... Analyzes BH member data to improve quality and appropriate utilization of services + Interacts with BH healthcare providers...Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- Prime Therapeutics (Tallahassee, FL)
- …post-degree clinical experience. + Experience in managed care, specialty drugs, care management and utilization review. + Meets Magellan Credentialing criteria. ... and drives every decision we make. **Job Posting Title** Infusion Referral Nurse - REMOTE **Job Description Summary** Under supervision, is responsible for performing… more
- CenterWell (Tallahassee, FL)
- …driver's license, auto insurance and reliable transportation. + Two years as a Registered Nurse with at least one-year of management experience in a home care, ... review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and conducts… more
- Highmark Health (Tallahassee, FL)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements the effective utilization management strategies including: review of appropriateness of health ... Experience in a clinical setting **Preferred** + Certification in utilization management or a related field +...Family Therapist (LMFT) + Licensed Behavior Specialist + Registered Nurse . **Preferred** + None **SKILLS** + Working knowledge of… more
- MyFlorida (Tallahassee, FL)
- …position that reports to the Director of the Healthcare Quality and Clinical Management Unit for the Office of Children's Medical Services Managed Care Plan. This ... and activities which include but are not limited to Care Coordination/Case Management and Enhanced Care Coordination. Who We Are: Florida Department of Health… more
- HCA Healthcare (Tallahassee, FL)
- …work to deliver clinical excellence behind the scenes in data science, case management or transfer centers. Unlock your potential at HCA Florida Capital Hospital! ... established productivity guidelines. + Manages operating expenses, including the utilization of supplies and equipment. Identifies cost reduction opportunities and… more
- HCA Healthcare (Tallahassee, FL)
- …**Job Summary and Qualifications** Job Summary: Provide leadership for planning, management , implementation, integration and coordination of the unit in support of ... this role: + Enhance the department through performance improvement and appropriate utilization of resources. + Develop an operational system that supports a… more
- HCA Healthcare (Tallahassee, FL)
- …day to day operations, including but not limited to staffing allocations, bed management , patient throughput In this role you will: + Ensures compliance with all ... + Supports clinical practice and operational efficiency through leadership, systems utilization , and team participation. + Other duties as assigned Job Requirements:… more
- Sedgwick (Tallahassee, FL)
- …and consult review; and two (2) years of experience in daily application of nurse auditing, utilization review and bill review. **Skills & Knowledge** + ... providers including complex hospital, surgical, high level evaluation and management codes and/or technical bills. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** +… more