- 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 ... independent determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse (RN)** in the (appropriate state)… more
- CVS Health (Tallahassee, FL)
- …+ Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that...setting. + A Registered Nurse that holds an active, unrestricted… more
- Evolent (Tallahassee, FL)
- …+ Performs other duties as assigned. **The Experience You'll Need (Required):** + Registered Nurse or Licensed Practical/Vocational Nurse with a current, ... for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals.… more
- Humana (Tallahassee, FL)
- …We are not able to hire candidates that are currently living in Puerto Rico. + Registered Nurse with current in-state RN license + At least 3 years of varied ... community and help us put health first** The Pre-Authorization Nurse 2 reviews prior authorization requests for appropriate care... clinical RN nursing experience + Current TRICARE experience +… more
- HCA Healthcare (Tallahassee, FL)
- …license held, active FL RN licenserequiredwithin90 days of hire** + **Advanced Practice Registered Nurse license is acceptable for position if current and ... location._** It is an exciting time to be a nurse at HCA Healthcare! Come unlock your career potential...care with a focus on evaluating the appropriateness of clinical care, medical necessity, admission status, level of care,… more
- HCA Healthcare (Tallahassee, FL)
- …held, active FL RN license required within90 days of hire** + **Advanced Practice Registered Nurse license is acceptable for position if current and compliant** ... plan of care with a focus on evaluating the appropriateness of clinical care, medical necessity, admission status, level of care, and resource management.… more
- HCA Healthcare (Tallahassee, FL)
- …active FL RN license required within 90 days of hire** + **Advanced Practice Registered Nurse license is acceptable for position if current and compliant** + ... plan of care with a focus on evaluating the appropriateness of clinical care, medical necessity, admission status, level of care, and resource management.… more
- HCA Healthcare (Tallahassee, FL)
- …Supt must be obtained within 30 days of employment start date + (APRN) Advanced Practice Registered Nurse , or (RN) Registered Nurse + Associate Degree, ... accordance with established policies/procedures and holds staff accountable for quality and clinical outcomes in support of facility objectives. **What you will do… more
- HCA Healthcare (Tallahassee, FL)
- …options and costs to patient and patient families. **What qualifications you will need:** + Registered Nurse , or Advance Practice Registered Nurse (APRN) ... and accountability in ensuring all admissions and continued stays meet clinical criteria for appropriateness and medical necessity. Assesses discharge planning needs… more
- Highmark Health (Tallahassee, FL)
- …years of experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or related **SKILLS** ... 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