- Actalent (Sunrise, FL)
- Job Title: Behavioral Health Utilization Review NurseJob Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing requests for ... collaboration with the interdisciplinary team, the UMN handles tasks related to utilization review across various specialties, medical treatments, and services.… more
- University of Miami (Miami, FL)
- …Department of UMHC SCCC Business Operations has an exciting opportunity for a full time Utilization Review Case Manager to work to work remote. The incumbent ... retrospective chart reviews for clinical utilization and authorization. The Utilization Review Case Manager coordinates with the healthcare team for… more
- CVS Health (FL)
- …that promote high-quality healthcare for members. **Position Summary** The Associate Manager is responsible for oversight of Utilization Management staff. ... Works closely with functional area leadership team (department Associate Managers, Manager , and other key stakeholders such as Medical Directors, account… more
- AdventHealth (Altamonte Springs, FL)
- …reviews within 24 hours of admission; and when warranted by length of stay, utilization review plan, and/or best practice guidelines, on a continuing basis. + ... **The role you will contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use...to the Physician Advisor or designated leader for additional review as determined by department standards. Additionally, the UM… more
- Molina Healthcare (Orlando, FL)
- …(such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services ... (such as, therapeutic drug monitoring, drug regimen review , patient education, and medical staff interaction), and oversight (establishing and measuring performance… 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 training ... employment, unless an accommodation is granted as required by law._ The ** Utilization Management Representative I** will be responsible for coordinating cases for… more
- Molina Healthcare (Tampa, FL)
- …SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years ... set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing clinical knowledge and experience,… more
- AdventHealth (Orlando, FL)
- …125,000 outpatients each year **The role you'll contribute:** The RN Care Manager in collaboration with the patient/family, social workers, nurses, physicians and ... and progression through the continuum of care. The RN Care Manager ensures efficient and cost-effective care through appropriate resources monitoring, and… more
- HCA Healthcare (Tallahassee, FL)
- …position if current and compliant** + **Certification in Case Management, Nursing, or Utilization Review , preferred** + **Three years of nursing experience in ... supporting a balance of optimal care and appropriate resource utilization . The RN CM Care Coordinator will identify potential...we encourage you to apply for our RN Case Manager Part Time opening. We promptly review … more
- CenterWell (Orange Park, FL)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... community and help us put health first** The **Clinical Manager ** coordinates and oversees all direct care patient services...requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking… more