- 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 ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 's work assignments are varied… more
- CVS Health (Tallahassee, FL)
- …Must possess 1+ years of clinical experience in acute or post acute setting - Utilization Management is a 24/7 operation and the work schedule may include ... and external constituents in the coordination and administration of the utilization /benefit management function. + Typical office working environment with… 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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Centene Corporation (Tallahassee, FL)
- …to ensure appropriate care for members and supervises day-to-day activities of BH utilization management team. + Monitors behavioral health (BH) utilization ... performance, quality, and efficiency standards + Works with BH utilization management team to resolve complex BH...Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- CVS Health (Tallahassee, FL)
- …convenient and affordable. **Position Summary** This is a full-time remote Utilization Management Clinical Consultant opportunity for candidates residing in ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and is… 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
- Humana (Tallahassee, FL)
- …Previous Medicare/Medicaid experience a plus. + Previous experience in prior authorization, utilization management + Experience working with MCG or Interqual ... goal to put health first? The Prior Authorization, Registered Nurse , RN, Intern will review prior authorization requests for...review depending on case findings. + Educates providers on utilization and medical management processes. + Enters… 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
- HCA Healthcare (Tallahassee, FL)
- …**Introduction** Do you have the PRN career opportunities as an Operating Room Nurse PRN-Surgery Center you want with your current employer? We have an exciting ... Do you want to work as an Operating Room Nurse PRN-Surgery Center where your passion for creating positive...the instrument and equipment set-up for your OR, including utilization of preference cards and ability to anticipate your… more
- Humana (Tallahassee, FL)
- …part of our caring community and help us put health first** The Compliance Nurse Auditor reviews utilization management activities and documentation to ... an acute care, skilled and/or rehabilitation clinical setting + Experience with utilization management , pre-service denials and/or quality assurance audits in… 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
- Centene Corporation (Tallahassee, FL)
- …abuse across the continuum of care. Experience with managed care, case management , utilization management , or quality improvement. **License/Certification:** ... staff, provider and member satisfaction + Serve as resource and liaison on utilization , quality improvement and case management activities + For NH Health… more
- YesCare Corp (Tallahassee, FL)
- **Experience & Requirements** + Active license + Registered Nurse required + Minimum of three (3) years of management experience in a healthcare setting. + ... new hire and annual orientation and training activities. + Ensures site utilization and compliance with allYesCareand applicable client systems and applications. +… more
- Humana (Tallahassee, FL)
- …project management and/or process improvement experience + Minimum 3 years utilization management experience with exposure to grievance and appeals + ... following areas: benchmarking, business process analysis and re-engineering, change management and measurement, and/or process-driven systems requirements. Begins to… more