- CVS Health (Tallahassee, FL)
- …(RN) - active license. + 3+ Years of clinical experience. + 1+ Year of Utilization Review Management and/or Medical Management experience. + Must have active ... skills in a collaborative process to implement, coordinate, monitor and evaluate medical review cases. Applies the appropriate clinical criteria/guideline and… more
- 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...and setting of care. Essential Skills + Proficiency in utilization management and utilization review … more
- 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, ... Actalent is hiring a Utilization Management Nurse ! Job Description The...on department activities as assigned. Essential Skills + Clinical review + Utilization review +… more
- 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
- CVS Health (Tallahassee, FL)
- …in 1993, AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support ... UM ( utilization management) experience within an **outpatient** setting, concurrent review or prior authorization. + 5 years of a variety clinical experience… more
- CVS Health (Tallahassee, FL)
- …care **Preferred Qualifications** + NICU experience highly preferred + Managed care/ utilization review experience + Ability to multitask, prioritize and ... thinking and knowledge in clinically appropriate treatment, evidence-based care and medical necessity criteria for appropriate utilization of services. +… more
- CVS Health (Tallahassee, FL)
- …solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant to join our remote team. ... (AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We provide flexible,...experience in Nursing. + At least 1 year of Utilization Management experience in concurrent review or… more
- CenterWell (Tallahassee, FL)
- …will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review ... Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to… more
- 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 (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