• Utilization Management Nurse

    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
    CVS Health (08/15/25)
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  • Utilization Review Nurse

    Actalent (Sunrise, FL)
    Medical Directors and other Medical Management staff to direct utilization and capture data effectively. Responsibilities + Review prior authorization ... Utilization Management Nurse !Job Description The ...on department activities as assigned. Essential Skills + Clinical review + Utilization review +… more
    Actalent (08/21/25)
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  • Registered Nurse RN - Utilization

    Ascension Health (Pensacola, FL)
    …Provide health care services regarding admissions, case management, discharge planning and utilization review . + Review admissions and service requests ... planning needs with healthcare team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee and coordinate compliance… more
    Ascension Health (08/23/25)
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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, ... Actalent is hiring a Utilization Management Nurse ! Job Description The...on department activities as assigned. Essential Skills + Clinical review + Utilization review +… more
    Actalent (08/21/25)
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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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  • Utilization Management Nurse

    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 (08/15/25)
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  • Utilization Management Nurse

    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
    CenterWell (08/02/25)
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  • Utilization Review Spec Sr

    BayCare Health System (Clearwater, FL)
    …foundation of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior responsibilities include:** + Functions ... to ensure appropriate level of care through comprehensive concurrent review for medical necessity of outpatient observation...Nursing or Business **Experience:** + Required 2 years in Utilization Review or + Required 2 years… more
    BayCare Health System (08/22/25)
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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 (08/23/25)
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