- AdventHealth (Altamonte Springs, FL)
- …2 years utilizing InterQual and/or MCG . Minimum of three (3) years' experience as Registered Nurse ( RN ) in an acute clinical setting . Clinical experience ... rebilling. . Collaborates with pre-access, patient financial services, revenue integrity, utilization management and clinical department staff to obtain further… more
- Molina Healthcare (Orlando, FL)
- …materials and other related documentations. **JOB QUALIFICATIONS** **Required Education** + Registered Nurse or equivalent combination of Licensed Vocational ... Nurse (LVN) or Licensed Practical Nurse (LPN) with experience in lieu of ...years in one or more of the following areas: utilization management , case management , care… more
- Molina Healthcare (Orlando, FL)
- …Chief Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + ... as may be required. + Serves as a clinical resource for Utilization Management , Chief Medical Officer, Physicians, and Member/Provider Inquiries/Appeals. +… more
- Molina Healthcare (Orlando, FL)
- …performing one or more of the following activities: care review/ utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.), ... identifying opportunities for improvement. **JOB QUALIFICATIONS** **Required Education** + Registered Nurse or equivalent combination of Licensed Vocational… more
- Molina Healthcare (Orlando, FL)
- …integrated) performing one or more of the following activities: utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.). ... identifying opportunities for improvement. **Job Qualifications** **REQUIRED EDUCATION** : Registered Nurse or equivalent combination of Licensed Vocational… more
- Health First (Viera, FL)
- …ability to adapt to change * Demonstrated strong negotiation and conflict management skills **Job:** ** Registered Nurse * **Organization:** **Viera Hospital ... resource to all associates as the administrative representative for hospital-wide management and decision-making in the absence of administrative personnel, assuming… more
- Molina Healthcare (Orlando, FL)
- …on business need (up to 25%) **Job Qualifications** * Active and unrestricted Registered Nurse ( RN ) license or independent behavioral health license ... **Job Description** Looking for a Registrared Nurse or Licensed Social worker to support HealthPlans...experience in health care * Understanding of clinical operations: utilization management , case management , etc.… more
- Health First (Viera, FL)
- …with demonstrated success in operations management and quality improvement. * * Licensure:* Registered Nurse ( RN ) licensure in the State of Florida or ... hospital's financial forecast and capital budget for efficient resource utilization . 8. Implements labor and expense management ...Workspace may vary from open to confined, onsite, or remote . * May require travel to various facilities within… more
- Elevance Health (Altamonte Springs, FL)
- …and personalized support throughout the consumer's treatment journey._ **Title** : Medical Management Nurse Lead **Location:** This position will work a hybrid ... model ( remote and office). Ideal candidates will live within 50...Impact.** In addition to the responsibilities of the Medical Management Nurse role, the **Medical Management… more
- Health First (Viera, FL)
- *POSITION SUMMARY* The Clinical Charge Nurse BSN is fully engaged in providing Quality/No Harm, Customer Service and Stewardship by demonstrating leadership through ... interdisciplinary care transition rounds and planning of care for appropriate utilization , care transitions, and safe disposition. 5. Consistently and effectively… more