• Supervisor, Care Review (RN)

    Molina Healthcare (FL)
    …Care Access and Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/ utilization review , and/or other utilization ... clinical and non-clinical team activities to facilitate integrated, proactive utilization management, ensuring compliance with regulatory and accrediting standards.… more
    Molina Healthcare (07/27/25)
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  • Ops Registered Nursing Consultant

    MyFlorida (Miami, FL)
    …analysis activities. Skilled in the techniques of oral communication and methods of utilization review ; knowledge of complex medical terminology; ability to ... the last five (5) years; AND + Two (2) years of experience in medical records utilization review , including surgical chart abstraction; AND + Two (2) years… more
    MyFlorida (08/08/25)
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  • Medical Claim Review Nurse (RN)

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

    Centene Corporation (Tallahassee, FL)
    …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering… more
    Centene Corporation (07/31/25)
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  • Utilization Review Clinician - ABA

    Centene Corporation (Tallahassee, FL)
    …assess ABA Treatment Plans required. Knowledge of ABA services and BH utilization review process required. Experience working with providers and healthcare ... for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering… more
    Centene Corporation (08/02/25)
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  • Utilization Review Clinician…

    Monte Nido (Miami, FL)
    …lives while providing the opportunity for people to realize their healthy selves. ** Utilization Review Clinician** **Monte Nido** **Remote - EST or CST hours** ... strategies to provide comprehensive care within an intimate home setting. The Utilization Review **Clinician** is responsible for conducting daily administrative… more
    Monte Nido (06/21/25)
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  • Remote Utilization Review Nurse

    Actalent (Orlando, FL)
    …to validate the necessity and setting of care. Essential Skills + Proficiency in utilization management and utilization review + Experience with Interqual ... review the type of care being delivered, evaluate medical necessity, and contribute to discharge planning following established...and Medicare + Expertise in medical , acute care, concurrent review , and prior… more
    Actalent (08/08/25)
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  • Observation Utilization Review RN

    Trinity Health (Fort Lauderdale, FL)
    …Care Plans to ensure authorization for hospital stay. Hybrid Position **_Position Purpose:_** ** Utilization Review (UR) Nurses play a vital role in healthcare by ... hospital clinical experience is required.** Recent experience in case management, utilization review , discharge planning, ongoing monitoring and evaluation of… more
    Trinity Health (08/02/25)
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  • Utilization Management Nurse

    Actalent (Sunrise, FL)
    …UMN assists in complex cases, develops internal processes, and educates physicians on utilization review issues. The role involves managing continuity of care, ... satisfaction, safety, and appropriate length of stay. Responsibilities + Review prior authorization requests for medical necessity...on department activities as assigned. Essential Skills + Clinical review + Utilization review +… more
    Actalent (07/29/25)
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  • Part-time Pediatric / Family Medicine…

    Centene Corporation (Tallahassee, FL)
    … management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , ... with respect to clinical issues and policies. + Identifies utilization review studies and evaluates adverse trends... review studies and evaluates adverse trends in utilization of medical services, unusual provider practice… more
    Centene Corporation (08/02/25)
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