- 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 (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
- 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
- BayCare Health System (Tampa, 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 (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
- 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
- Molina Healthcare (Tampa, FL)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests additional information from members or providers in… more
- ChenMed (Pembroke Pines, FL)
- …engagement with patient and family. + Facilitate patient/family conferences to review treatment goals, optimize resource utilization , provide family education ... Participate in surveys, studies and special projects as assigned. + Conduct concurrent medical record review using specific indicators and criteria as approved… more
- Elevance Health (Miami, FL)
- …are 7am - 6pm EST and will include weekends. The ** Medical Management Nurse ** will be responsible for review of the most complex or challenging cases ... ** Medical Management Nurse ** **Location:** Virtual: This...experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or… more