• Registered Nurse - Supervisor/Assistant…

    Veterans Affairs, Veterans Health Administration (Miami, FL)
    …Assessments (CAAs) that are assigned to nursing, adhering to current Centers for Medicare and Medicaid Services ( CMS ) and Veterans Health Administration (VHA) ... in the CLC. Documenting and taking corrective action when notified by the CLC management team, charge nurse , or designee of any discrepancies in coding or… more
    Veterans Affairs, Veterans Health Administration (08/09/25)
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  • Nurse Practitioner

    Gentiva (Plantation, FL)
    …certification or recertification of a patient's terminal diagnosis, in accordance with CMS requirements. **As a Hospice Nurse Practitioner, You Will:** + ... you may be the perfect fit for our Hospice Nurse Practitioner opportunity. You'll report directly to the Executive...plans to support hospice eligibility + Adhere to the CMS -mandated timeframe for F2F assessments + Ensure all documentation… more
    Gentiva (08/14/25)
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  • Registered Nurse RN Care Manager East

    AdventHealth (Orlando, FL)
    …patient satisfaction, patient safety, readmission prevention and length of stay management . The RN Care Manager communicates daily with the interdisciplinary team ... core competencies of this role. The RN Care Manager facilitates the collaborative management of patient care across the continuum, intervening to remove barriers to… more
    AdventHealth (08/15/25)
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  • Utilization Management Nurse

    Actalent (Sunrise, FL)
    Actalent is hiring a Utilization Management Nurse ! Job Description The Utilization Management Nurse (UMN) collaborates closely with the interdisciplinary ... InterQual + Milliman Commercial Guidelines + Medicaid + Medical management + Medicare + Managed care +...Milliman Criteria. + Knowledge of Florida Medicaid Program and CMS Guidelines. + Proficient in word processing software, spreadsheet… more
    Actalent (08/15/25)
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  • Hybrid Clinical Review Nurse

    Actalent (Sunrise, FL)
    Utilization Management Nurse !Job Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing service authorization requests to ... Interqual + Milliman Commercial Guidelines + Medicaid + Medical management + Medicare + Managed care +...including InterQual and Milliman Criteria, Florida Medicaid Program, and CMS Guidelines. + Knowledge of community and post-acute resources… more
    Actalent (08/09/25)
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  • Clinical Appeals Nurse (RN)

    Molina Healthcare (Tampa, FL)
    …outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases ... Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + Identifies and reports… more
    Molina Healthcare (08/15/25)
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  • Utilization Management Nurse

    CenterWell (Tallahassee, FL)
    …DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/ Medicare ... in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part… more
    CenterWell (08/08/25)
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  • Utilization Management Nurse

    CenterWell (Tallahassee, FL)
    …procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/ Medicare ... in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part… more
    CenterWell (08/02/25)
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  • VP Quality AdventHealth Central Florida Division…

    AdventHealth (Altamonte Springs, FL)
    …and forecast upcoming regulatory and public-reporting trends such as Centers for Medicare and Medicaid Services ( CMS ) Value-Based Purchasing, Agency for ... **GENERAL SUMMARY** **:** The Vice President of Quality serves as the health system expert and executive sponsor with responsibility for developing and executing a… more
    AdventHealth (08/07/25)
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  • Clinical Program Manager- Payment Integrity…

    Molina Healthcare (Miami, FL)
    …to achieve operational goals and executes tasks and projects to ensure Centers for Medicare & Medicaid Services ( CMS ) and State regulatory requirements are met ... **Job Summary** **_For this position we are seeking a (RN) Registered Nurse who must be licensed for the state of KENTUCKY or have a compact license._** Provides… more
    Molina Healthcare (08/14/25)
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