- Elevance Health (FL)
- …in an ambulatory or hospital setting or minimum of 1 year of prior utilization management , medical management and/or quality management , and/or ... ** Nurse Reviewer I** **Location:** This role enables associates...required. **Preferred Experience, Skills, and Capabilities:** + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding,… more
- Elevance Health (FL)
- …in an ambulatory or hospital setting or minimum of 1 year of prior utilization management , medical management and/or quality management , and/or ... **Appeals Nurse Reviewer I** **Location:** This role enables associates...required. **Preferred Experience, Skills, and Capabilities:** + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding,… more
- AdventHealth (Minneola, FL)
- …as part of various other teams, including but not limited to Care Management nurses and social workers, nursing , home care liaisons, physicians, pharmacists, ... value you'll bring to the team:** Adheres to the nursing care Scope of Practice and Care Management...critical care **LICENSURE, CERTIFICATION, OR REGISTRATION PREFERRED:** + Case Management certification Accredited Case Manager (ACM) +… more
- ChenMed (Miami, FL)
- …the quality and efficacy of the organization's telehealth practices and professional nursing practice through successful utilization and improvement of outcomes ... CRITERIA:** + Associate Degree in Nursing required, Bachelor's Degree in Nursing preferred + Nurse Licensure Compact required- multistate nursing … more
- AdventHealth (Maitland, FL)
- …as part of various other teams, including but not limited to Care Management nurses and social workers, nursing , home care liaisons, physicians, pharmacists, ... respectful to all.** **The value you'll bring to the team:** + Adheres to the nursing care Scope of Practice and Care Management Scope of Service in achieving… more
- Prime Therapeutics (Tallahassee, FL)
- …Patient Programs. **Education & Experience** + Associates - Nursing + Bachelors - Nursing + RN - Registered Nurse , State and/or Compact State Licensure - ... of post-degree clinical experience. + Experience in managed care, specialty drugs, care management and utilization review. + Meets Credentialing criteria. + At… more
- Fresenius Medical Center (Miami, FL)
- …post procedure, under the direction of the Facility Manager , Director of Nursing and/or Charge Registered Nurse , utilizing standard nursing techniques to ... on adverse events and action thresholds in collaboration with facility management . + Maintains integrity of medical records and other organization administrative… more
- CenterWell (Tallahassee, FL)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and ... experience in a high volume and fast paced environment + Previous experience in utilization management + Education: BSN or Bachelor's degree in a related field… more
- Molina Healthcare (Tampa, FL)
- …of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. ... **REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical… more
- AdventHealth (Land O' Lakes, FL)
- …a specific group of patients.The Case Manager is responsible for utilization reviews and resource management , discharge planning, treatment plan ... TWCE as Nice **The role you'll contribute:** The Case Manager is accountable for the organization, sequence of services...to succeed: .ADN, RN .Two (2) years of hospital nursing experience .Current license of registered nurse … more
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