• Appeals Nurse

    Evolent (Tallahassee, FL)
    …focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and procedures ... work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators...Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
    Evolent (05/10/25)
    - Related Jobs

  • Medical Director - Medicaid N. Central

    Humana (Tallahassee, FL)
    …this knowledge in their daily work. The Medical Director's work includes computer- based review of moderately complex to complex clinical scenarios, ... with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health… more
    Humana (05/14/25)
    - Related Jobs

  • Medical Director - Mid West Region

    Humana (Tallahassee, FL)
    …this knowledge in their daily work. The Medical Director's work includes computer- based review of moderately complex to complex clinical scenarios, ... with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health… more
    Humana (05/14/25)
    - Related Jobs

  • Medical Director - Care Plus - Florida

    Humana (Tallahassee, FL)
    …this knowledge in their daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, review ... with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health… more
    Humana (04/24/25)
    - Related Jobs

  • RN Case Manager PRN

    HCA Healthcare (Gainesville, FL)
    …is preferred . BSN is preferred . Certification in Case Management, Nursing or Utilization Review is preferred HCA Florida North Florida Hospital is a 523-bed, ... protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care...a 100% match on 3% to 9% of pay ( based on years of service) + Employee Stock Purchase… more
    HCA Healthcare (03/04/25)
    - Related Jobs

  • Registered Nurse RN Care Manager East

    AdventHealth (Orlando, FL)
    …to nurses, physicians and the interdisciplinary team on issues related to utilization of resources, medical necessity, CMS CoP for Discharge Planning and care ... available to the patient including, but not limited to the following: Home Health, Infusion Services, Durable Medical Equipment, Palliative Care, Hospice, Outpatient… more
    AdventHealth (05/12/25)
    - Related Jobs

  • RN Case Manager

    HCA Healthcare (Gainesville, FL)
    …is preferred + BSN is preferred + Certification in Case Management, Nursing or Utilization Review is preferred HCA Florida North Florida Hospital is a 523-bed, ... protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care...a 100% match on 3% to 9% of pay ( based on years of service) + Employee Stock Purchase… more
    HCA Healthcare (04/23/25)
    - Related Jobs

  • Physician - Physician Advisor

    Ascension Health (Jacksonville, FL)
    …your community _Benefit options and eligibility vary by position. Compensation varies based on factors including, but not limited to, experience, skills, education, ... recent work experience in a hospital setting, preferably with some Physician Advisory/ Utilization Management work experience. If you are ready to join a talented… more
    Ascension Health (05/14/25)
    - Related Jobs

  • Clinical Appeals Nurse (RN)

    Molina Healthcare (Orlando, FL)
    …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + Identifies and… more
    Molina Healthcare (05/16/25)
    - Related Jobs

  • RN Case Mgr

    HCA Healthcare (Fort Pierce, FL)
    …2 years of critical care experience + Certification in case management or utilization review preferred + InterQual experience preferred HCA Florida Lawnwood ... protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care...a 100% match on 3% to 9% of pay ( based on years of service) + Employee Stock Purchase… more
    HCA Healthcare (05/08/25)
    - Related Jobs