- Actalent (Sunrise, FL)
- Job Title: Behavioral Health Utilization Review NurseJob Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing requests ... services. Under the general supervision of the Director and/or Manager /Supervisor of Medical Management , and in collaboration...+ Valid Florida Driver's License. + Knowledge of case management and utilization review concepts,… more
- Humana (Tallahassee, FL)
- **Become a part of our caring community and help us put health first** The Manager , Utilization Management Nursing (LTSS Utilization Management ... communication of medical services and/or benefit administration determinations. The Manager , Utilization Management Nursing works...of Michigan. + Previous experience in utilization management and/or utilization review . +… more
- Molina Healthcare (Orlando, FL)
- … (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management ), clinical pharmacy ... **JOB DESCRIPTION** **Job Summary** Molina Pharmacy Services/ Management staff work to ensure that Molina members have access to all medically necessary prescription… more
- Elevance Health (Miami, FL)
- ** Utilization Management Representative I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person ... employment, unless an accommodation is granted as required by law._ The ** Utilization Management Representative I** will be responsible for coordinating cases… more
- Carnival Cruise Line (Miami, FL)
- This role reports to the Senior Manager of Case Management and oversees the daily operations of crew case management . The Manager leads a team of ... employing over 160,000 crew members. **Essential Functions:** + **Case Management Oversight** + Manage and review cases,...schedule for crew medical support. + Support the Senior Manager of Case Management in developing and… more
- Carnival Cruise Line (Miami, FL)
- This role reports to the Senior Manager of Case Management and oversees the daily operations of crew case management . The Manager leads a team of ... stakeholders, supporting disability claims, and facilitating return-to-work planning. The Manager also escalates high-risk cases, conducts utilization reviews,… more
- Cleveland Clinic (Port Saint Lucie, FL)
- …A caregiver in this role utilizes clinical expertise and understanding of utilization review requirements, discharge planning process, and Medicare regulations ... where you belong, here at Tradition Hospital. As a Manager of Care Management , you will supervise...in the development of department practices and procedures for utilization review and discharge planning, ensuring compliance… 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. ... SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years… more
- HCA Healthcare (Brandon, FL)
- …growth, we encourage you to apply for our Manager of Case Management opening. We promptly review all applications. Highly qualified candidates will be ... Qualifications** We are currently looking for an ambitious Case Management Manager to help us reach our...supporting a balance of optimal care and appropriate resource utilization . **What qualifications you will need:** + Bachelor's Degree… more
- HCA Healthcare (Inverness, FL)
- …growth, we encourage you to apply for our Manager of Case Management opening. We promptly review all applications. Highly qualified candidates will be ... Qualifications** We are currently looking for an ambitious Case Management Manager to help us reach our...supporting a balance of optimal care and appropriate resource utilization . What qualifications you will need: + Bachelor's Degree… more