- CVS Health (Tallahassee, FL)
- …more personal, convenient and affordable. **Position Summary** This is a full-time remote Utilization Management Clinical Consultant opportunity for ... to coordinate, document and communicate all aspects of the utilization /benefit management program. + Applies critical thinking...+ Licensed Independent Behavioral Health clinician or an unrestricted Registered Nurse ( RN ) license in… more
- Humana (Tallahassee, FL)
- …professional onsite, field, or remote based opportunities. The Prior Authorization, Registered Nurse , RN , Intern will utilize Humana's Medicaid training ... the goal to put health first? The Prior Authorization, Registered Nurse , RN , Intern will...experience a plus. + Previous experience in prior authorization, utilization management + Experience working with MCG… more
- 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 ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...the State of Florida + Bachelor's degree + Licensed Registered Nurse ( RN ) in the… more
- Centene Corporation (Tallahassee, FL)
- …Family Therapist (LMFT) required or + Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State ... care for members and supervises day-to-day activities of BH utilization management team. + Monitors behavioral health...plus holidays, and a flexible approach to work with remote , hybrid, field or office work schedules. Actual pay… more
- Humana (Tallahassee, FL)
- …and help us put health first** Humana Healthy Horizons in Florida is seeking a Utilization Management Nurse who utilizes clinical nursing skills to support ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 's work assignments...Active Licensed Practical Nurse , (LPN) or Licensed Registered Nurse ( RN ) in the… more
- Centene Corporation (Tallahassee, FL)
- …Family Therapist (LMFT) required or + Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- Highmark Health (Tallahassee, FL)
- …Sunday required in addition to 3 weekdays** This job implements effective utilization management strategies including: review of appropriateness of health care ... depending on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field **SKILLS** + Working knowledge of… more
- Guardian Life (Tallahassee, FL)
- …services. Act as a liaison between all parties required in case management to facilitate collaboration toward RTW goals. Utilization of independent ... **Position Summary** The RN Clinical Consultant serves as a clinical resource...plan and length of disability. Plan for ongoing case management through proactive partnering with treating providers to move… more
- Centene Corporation (Tallahassee, FL)
- …and Family Therapist (LMFT) required or Licensed Mental Health Professional (LMHP) required or RN - Registered Nurse - State Licensure and/or Compact State ... Complies with all policies and standards **_This is a remote position available for candidates licensed in FL. The...the continuum of care. Experience with managed care, case management , utilization management , or quality… more
- Humana (Tallahassee, FL)
- …your skills to make an impact** **Required Qualifications** + Associate degree + Active Registered Nurse , ( RN ), License in your state of residence without ... project management and/or process improvement experience + Minimum 3 years utilization management experience with exposure to grievance and appeals +… more