• Medical Claim Review Nurse

    Molina Healthcare (St. Petersburg, FL)
    …DESCRIPTION** **Job Summary** Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate ... + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years of experience in… more
    Molina Healthcare (08/08/25)
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  • Hybrid Clinical Review Nurse

    Actalent (Sunrise, FL)
    …staff to direct utilization and capture data effectively. Responsibilities + Review prior authorization requests for medical necessity and appropriateness, ... Utilization Management Nurse !Job Description The Utilization Management Nurse ...standardized Review Criteria. + Coordinate with the Medical Director/Physicians for requests outside standard Review more
    Actalent (08/09/25)
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  • Clinical Review Nurse

    Actalent (Orlando, FL)
    Job Title: Clinical Review NurseJob Description: The Review Nurse will be responsible for reviewing approximately 20 cases a day to assess medical ... decisions and gather additional information about the member's condition. Responsibilities: + Review approximately 20 cases a day for medical necessity. +… more
    Actalent (08/02/25)
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  • Remote Utilization Review Nurse

    Actalent (Orlando, FL)
    Job Title: Clinical Review Nurse Job Description As a Clinical Review Nurse , you will perform concurrent reviews to assess members' overall health, ... review the type of care being delivered, evaluate medical necessity, and contribute to discharge planning following established...+ Experience with Interqual and Medicare + Expertise in medical , acute care, concurrent review , and prior… more
    Actalent (08/08/25)
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  • Utilization Review - Registered…

    Community Health Systems (Naples, FL)
    **Job Summary** Under the direction of the UR Director/Manager the UR Nurse reviews all admissions for medical necessity, correct orders based on medical ... on performance improvement of the UR KPI's. Ensures proper and accurate medical record documentation. **Essential Functions** + Reviews new admissions using 3rd… more
    Community Health Systems (07/12/25)
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  • Clinical Review Nurse - Concurrent…

    Centene Corporation (Tallahassee, FL)
    …for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering ... member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies… more
    Centene Corporation (08/08/25)
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  • Care Review Clinician, Prior Auth (RN) Pega…

    Molina Healthcare (Tampa, FL)
    …within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests additional information from members or providers in ... meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN). **Required Experience** 1-3 years of hospital or … more
    Molina Healthcare (07/12/25)
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  • Registered Nurse Peer Review

    AdventHealth (Ocala, FL)
    …The Coordinator Professional Practice Evaluation is responsible for facilitating the medical staff Peer Review , Ongoing Professional Practice Evaluation (OPPE) ... Policy. This includes the analysis of events that require peer review and the examination of medical records as identified by clinical indicators or triggers is… more
    AdventHealth (08/08/25)
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  • Flight Registered Nurse (RN)

    Vighter Medical Group (Jacksonville, FL)
    …to DHS/ICE detainees being repatriated to their countries of origin. The RN will review medical records to determine if detainees are capable of flying and ... Flight Registered Nurse (RN), Jacksonville, FL Job Details Job Location...Customs Enforcement. Healthcare is delivered in accordance with approved medical protocols and in compliance with Department of Homeland… more
    Vighter Medical Group (07/01/25)
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  • Nurse Educator - Medical Simulation…

    University of Miami (Miami, FL)
    Medical Training Lab at the Gordon Center is currently seeking a full time Nurse Educator - Medical Simulation and Education Lab to work in Miami, FL. The ... faculty or staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The University of… more
    University of Miami (07/24/25)
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