- Centene Corporation (Tallahassee, FL)
- …flexibility. **Must Reside in Florida!** **Centene is Hiring!** **We're looking for a Remote Concurrent Review Nurse to support our Medicaid team.** **Ideal ... needed to discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member… more
- Actalent (Sunrise, FL)
- Job Title: Behavioral Health Utilization Review NurseJob Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing requests for ... with the interdisciplinary team, the UMN handles tasks related to utilization review across various specialties, medical treatments, and services. The role involves… more
- AdventHealth (Daytona Beach, FL)
- …**The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use clinical expertise by analyzing patient records to ... order or a status conflict is indicated, the UM nurse is responsible for escalation to the Physician Advisor...to the Physician Advisor or designated leader for additional review as determined by department standards. Additionally, the UM… more
- AdventHealth (Celebration, FL)
- …the defeat of illness and disease **The role you'll contribute:** The Clinical Nurse Education Facilitator (CNEF) is an expert clinician, highly skilled in nursing ... and thinking + **Develops goal-oriented plans and timelines for each nurse based on performance, knowledge/skills assessment, observation, and feedback from unit… more
- Cognizant (Tallahassee, FL)
- …to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work related to clinical ... as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral,...have to be considered** . Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization… more
- Wellpath (Fort Lauderdale, FL)
- …and acute care using InterQual Criteria, ensuring adherence to department procedures. * Review concurrent clinical information and document it in the ERMA Care ... of care support. **How you make a difference** The Utilization Management Registered Nurse works under the guidance of the Utilization Provider to oversee the… more
- AdventHealth (Altamonte Springs, FL)
- …role you will contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use clinical expertise by analyzing patient records to determine ... order or a status conflict is indicated, the UM nurse is responsible for escalation to the Physician Advisor...to the Physician Advisor or designated leader for additional review as determined by department standards. Additionally, the UM… more
- Centene Corporation (Tallahassee, FL)
- …medical appropriateness in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine ... a fresh perspective on workplace flexibility. **Position Purpose:** Performs a clinical review and assesses care related to mental health and substance abuse.… more
- HCA Healthcare (Kissimmee, FL)
- …database to ensure adequate documentation as required by regulatory agencies. + Complete concurrent review of cases to identify quality, timelines and systems of ... and Patient Safety (PIPS) Program. The PI Coordinator will review the continuum of care to determine compliance with...6 months of employment start date + (RN) Registered Nurse + Associate Degree, or Registered Nurse … more
- HCA Healthcare (Miami, FL)
- …Summary and Qualifications** The Quality Coordinator is responsible for performing concurrent and retrospective quality management / practice improvement reviews as ... defined by the individual departments / divisions including complication & mortality review , national quality indicator review , TJC indicator/standards review… more