- CenterWell (Tallahassee, FL)
- … clinical RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity ... and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that… more
- Centers Plan for Healthy Living (Margate, FL)
- …currently accepting applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works within a ... in their home to improve their quality of life. Utilization Management Clinical Reviewer will...care managers and believe that coordinating high quality clinical and social services will result in better … more
- ChenMed (Miami, FL)
- …The Physician Reviewer is the primary physician reviewer for Utilization Management/ Clinical Appropriateness review cases in our organization. Other ... experience in Hospital medicine preferred + At least one (1) year of utilization review experience preferred We're ChenMed and we're transforming healthcare for… more
- Centene Corporation (Tallahassee, FL)
- …the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, ... of Florida to be considered. **Position Purpose:** Authorize, direct and monitor care for behavioral health and/or substance abuse problems according to clinical… more
- HCA Healthcare (Gainesville, FL)
- …Eligibility for benefits may vary by location._** Come join our team as a Behavioral Health Utilization Review RN MSW. We care for our community! Just last ... like family! Jump-start your career as a Behavioral Health Utilization Review RN MSW today with Parallon....application and use of InterQual + Analyze documentation of clinical care from the electronic medical record… more
- Centene Corporation (Tallahassee, FL)
- …benefits including a fresh perspective on workplace flexibility. **Position Purpose:** Performs a clinical review and assesses care related to mental health ... and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and… more
- HCA Healthcare (Clearwater, FL)
- **Description** **Introduction** Do you have the career opportunities as a Utilization Review Services Coordinator you want with your current employer? We have ... and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. +...of colleagues. Do you want to work as a Utilization Review Services Coordinator where your passion… more
- CVS Health (Tallahassee, FL)
- …active license. + 3+ Years of clinical experience. + 1+ Year of Utilization Review Management and/or Medical Management experience. + Must have active and ... in a collaborative process to implement, coordinate, monitor and evaluate medical review cases. + Applies the appropriate clinical criteria/guideline and plan… more
- Actalent (Sunrise, FL)
- …+ Prepare and present reports on department activities as assigned. Essential Skills + Clinical review + Utilization review + Utilization ... UMN assists in complex cases, develops internal processes, and educates physicians on utilization review issues. The role involves managing continuity of care… more
- CVS Health (Tallahassee, FL)
- … Management. AHH delivers flexible medical management services that support cost-effective quality care for members. + Work in clinical telephone queue for 3 ... a day working with providers to secure additional information for prior authorization review . + This candidate will utilize clinical skills to coordinate,… more