• Utilization Management Nurse

    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
    CVS Health (03/15/25)
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  • Manager, Utilization Management

    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 (03/12/25)
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  • Utilization Management Behavioral…

    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 (03/15/25)
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  • Manager, Utilization Management

    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 (03/12/25)
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  • Pre-Authorization Registered Nurse

    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
    Humana (03/15/25)
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  • Registered Nurse Specialist

    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
    MyFlorida (03/13/25)
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  • Operating Room Nurse - Surgery Center

    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
    HCA Healthcare (02/20/25)
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  • Case Manager, Registered Nurse - Fully…

    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
    CVS Health (03/14/25)
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  • Registered Nurse (On call)

    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
    MTC (03/04/25)
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  • Interim Manager of Case Management

    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
    HealthTrust Workforce Solutions (03/14/25)
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  • Manager Case Management

    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
    HCA Healthcare (02/18/25)
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  • Chief Clinical Officer

    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
    Evolent (12/21/24)
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  • RN Case Manager

    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
    HCA Healthcare (03/12/25)
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  • Care Manager RN (Delaware) Remote

    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
    Highmark Health (02/20/25)
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  • Registered Nursing Consultant

    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 (03/11/25)
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  • Health Support Aide

    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
    MyFlorida (03/04/25)
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  • Lead Family Health Advocate- Remote

    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 (03/04/25)
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  • Family Health Advocate- Remote

    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 (02/11/25)
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  • Manager Emergency Services Southwood FSED

    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 (02/20/25)
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  • Clinical Letter Writer (Part-time) - RN, LVN/LPN…

    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
    Evolent (03/11/25)
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