- CVS Health (Tallahassee, FL)
- …Must have active current and unrestricted RN licensure in state of residence - Utilization management is a 24/7 operation. Work schedules will include weekend, ... in med surg or specialty area - Managed Care experience preferred, especially Utilization Management - Preference for those residing in EST or CST zones -… more
- Humana (Tallahassee, FL)
- …of our caring community and help us put health first** The Manager, Utilization Management Nursing utilizes clinical nursing skills to support the coordination, ... communication of medical services and/or benefit administration determinations. The Manager, Utilization Management Nursing works within specific guidelines and… more
- Humana (Tallahassee, FL)
- …part of our caring community and help us put health first** The Utilization Management Behavioral Health Professional 2 utilizes behavioral health knowledge and ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional 2 work assignments… more
- Humana (Tallahassee, FL)
- …of our caring community and help us put health first** The Manager, Utilization Management Behavioral Health utilizes behavioral health knowledge and skills to ... of medical services and/or benefit administration determinations. The Manager, Utilization Management Behavioral Health works within specific guidelines… more
- Humana (Tallahassee, FL)
- …licensure + Previous Medicare/Medicaid experience a plus + Previous experience in utilization management , case management , discharge planning and/or home ... stakeholders for review depending on case findings. + Educates providers on utilization and medical management processes. + Enters and maintains pertinent… more
- MyFlorida (Chattahoochee, FL)
- REGISTERED NURSE SPECIALIST - 60006454 Date: Mar 8, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... . Requisition No: 843100 Agency: Children and Families Working Title: REGISTERED NURSE SPECIALIST - 60006454 Pay Plan: Career Service Position Number: 60006454… more
- HCA Healthcare (Tallahassee, FL)
- …Center have the opportunity to make a real impact. As an Operating Room Nurse - Surgery Center you can be a part of change. **Benefits** Tallahassee Outpatient ... location._** It is an exciting time to be a nurse at HCA Healthcare! Come unlock your career potential...the instrument and equipment set-up for your OR, including utilization of preference cards and ability to anticipate your… more
- CVS Health (Tallahassee, FL)
- …or having all 50 state licenses. This role is a blended role doing both Case Management and Utilization Management . The RN Case Manager is responsible for ... - 5+ years clinical practice experience as an RN - 6+ months Case Management or Utilization Management experience - Must be willing and able to work Monday… more
- MTC (Quincy, FL)
- …record or other forms as appropriate. + Practice basic cost containment and utilization management for inmate care and facility operations. + Maintain absolute ... of Florida with an acceptable driving record required, unless waived by management . Management & Training Corporation (MTC) is an Equal Opportunity Employer. All… more
- HealthTrust Workforce Solutions (Tallahassee, FL)
- …budget and resource management , cost control, contract compliance, quality improvement, utilization management , denials management and management of ... jobs nationwide. **_JOB SUMMARY_** The Interim Leader of Case Management Services is a Registered Nurse who...that the following functions of the role are completed: Utilization Review for medical necessity of admission and concurrent… more
- HCA Healthcare (Tallahassee, FL)
- **Description** **Introduction** Do you have the career opportunities as a(an) Manager Case Management you want in your current role? We invest in what matters most ... meet these needs. + Develops, initiates, and coordinates individual patient case management plans to ensure appropriate level of care across the continuum. Ensures… more
- Evolent (Tallahassee, FL)
- …for operational performance of physician, nursing, and shared services staff in the utilization management value chain + Owns clinical rationale for ... point of responsibility for all clinical operations inclusive of nurse , physician, and shared services performance. and core work...utilization management decisions made by all clinical staff + Ensures… more
- HCA Healthcare (Tallahassee, FL)
- …and assess observation patients for appropriateness in observation status + Performs utilization management reviews and communicates information to third party ... location._** It is an exciting time to be a nurse at HCA Healthcare! Come unlock your career potential... Management experience preferred + Certification in Case Management , Nursing, or Utilization Review, preferred HCA… more
- Highmark Health (Tallahassee, FL)
- …Health **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... Care **LICENSES or CERTIFICATIONS** **Required** + United States Registered Nurse (RN) license + Delaware RN license must be...is part of the compact **Preferred** + Certification in Utilization Management or a related field **SKILLS**… more
- MyFlorida (Chattahoochee, FL)
- …literature on relevant quality management topics to staff and management . Works with nurse managers/department leaders to ensure regular clinical ... Quality Improvement Department at Florida State Hospital. The Quality Assurance/Improvement nurse optimizes the quality of care across the facility by undertaking… more
- MyFlorida (Quincy, FL)
- …for students (after training), takes vital signs and refers abnormal results to the nurse . In absence of the nurse , notify the principal before contacting ... perform unsatisfactorily on initial screening examinations for evaluation by the school nurse . Transport client's identifiable information in a secure locked bag for… more
- Sharecare (Tallahassee, FL)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- Sharecare (Tallahassee, FL)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… 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
- Evolent (Tallahassee, FL)
- …identifies and refers quality issues to the Senior Director of Medical Management or Medical Director. + Appropriately identifies potential cases for Care ... Management programs + Communicates appropriate information to other staff...as assigned. **Qualifications: Required and Preferred:** + Licensed registered nurse or LVN/LPN (current and unrestricted) + Minimum of… more