- Actalent (Sunrise, FL)
- Job Title: Behavioral Health Utilization Review NurseJob Description We are seeking a dedicated Utilization Management Nurse (UMN) who will work ... cases, internal process development, and provide education to the team on utilization review -related issues. Responsibilities + Review prior authorization… more
- 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
- BayCare Health System (Tampa, FL)
- …of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior/RN responsibilities include:** + Functions ... + Preferred ACM (Case Management) + Preferred CCM (Case Manager ) **Education:** + Required Associates in Nursing or +...Nursing or Business **Experience:** + Required 2 years in Utilization Review or + Required 2 years… 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
- 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
- AdventHealth (Orlando, FL)
- **Quality Review Nurse RN PRN Home Care AdventHealth Home Health** **All the benefits and perks you need for you and your family:** + Benefits from Day One + Paid ... FL, 32804 **The role you'll contribute:** Responsible for ensuring effective utilization and case management oversight activities as defined by interprofessional… 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