- Community Health Systems (Naples, FL)
- **Job Summary** Under the direction of the UR Director/Manager the UR Nurse reviews all admissions for medical necessity, correct orders based on medical condition ... (inpt vs OBS). Facilitates concurrent reviews and authorizations for admissions. This position will...programs + Addresses facility and departmental communication through daily review of all correspondence, including incoming email messages. +… more
- AdventHealth (Ocala, FL)
- …the team:** + Assures compliance with professional practice evaluation through concurrent and retrospective review , identification of deficiencies, and ... Practice Evaluation is responsible for facilitating the medical staff Peer Review , Ongoing Professional Practice Evaluation (OPPE) and Focused Professional Practice… more
- AdventHealth (Riverview, FL)
- …appropriate leaders for analysis and corrective action to improve quality outcomes. Assures concurrent review is performed on those patients that may trigger ... organizational status in relation to assigned core measure(s) Performs concurrent data review and rounding for assigned...platform or data collection within a healthcare setting. Registered Nurse (RN) Licensed Practical Nurse (LPN) or… more
- Actalent (Sunrise, FL)
- …+ Medicare + Managed care + Patient care + Medical record + Case management + Concurrent review + Discharge planning + Medical + Acute care Additional Skills & ... Actalent is hiring a Utilization Management Nurse ! Job Description The Utilization Management Nurse...cases, develops internal processes, and educates physicians on utilization review issues. The role involves managing continuity of care,… more
- AdventHealth (Tampa, 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
- ChenMed (Pembroke Pines, FL)
- …+ Participate in surveys, studies and special projects as assigned. + Conduct concurrent medical record review using specific indicators and criteria as approved ... We're rapidly expanding and we need great people to join our team. The Nurse Case Manager I position is responsible for achieving positive patient outcomes and… more
- ChenMed (North Miami Beach, FL)
- …+ Participates in surveys, studies and special projects as assigned. + Conducts concurrent medical record review using specific indicators and criteria as ... expanding and we need great people to join our team. The Acute Care Nurse (RN) is responsible for achieving positive patient outcomes and managing quality of care… more
- CVS Health (Tallahassee, FL)
- …+ 1 year of varied UM (utilization management) experience within an **outpatient** setting, concurrent review or prior authorization. + 5 years of a variety ... + 1 year of varied UM (utilization management) experience within an inpatient, concurrent review or prior authorization. + Remote work experience. **Education**… more
- ChenMed (Opa Locka, FL)
- …+ Participates in surveys, studies and special projects as assigned. + Conducts concurrent medical record review using specific indicators and criteria as ... we need great people to join our team. The Nurse Case Manager 1 (RN) is responsible for achieving...with patient and family. + Facilitates patient/family conferences to review treatment goals and optimize resource utilization; provides family… 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