- 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
- Evolent (Tallahassee, FL)
- …team approach with call center staff. Clinical Reviewers are supported by Field Medical Directors (MDs) in the utilization management determination process. + ... it. **What You'll Be Doing:** As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We can offer you a meaningful way… more
- Evolent (Tallahassee, FL)
- …team approach with call center staff. Clinical Reviewers are supported by Field Medical Directors (MDs) in the utilization management determination process. + ... culture. **What You'll Be Doing:** As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We can offer you a meaningful way… more
- Veterans Affairs, Veterans Health Administration (Gainesville, FL)
- …and from the community. Possesses the knowledge related to VHA guidelines, utilization review criteria, current evidence-based standards of care, compliance ... Health System (NF/SG VAHS) is recruiting for a Registered Nurse Care Coordinator to work in the Office of...Office of Community Care at the Malcom Randall VA Medical Center. The RN Care Coordinator uses the nursing… more
- Veterans Affairs, Veterans Health Administration (Bay Pines, FL)
- Summary The Assistant Chief Nurse executes leadership that is characterized by substantial and continuous responsibility and accountability for population groups or ... include the Inpatient Acute Care Units (critical care and medical surgical), and the Emergency Department. Specific Acute Care...of the Veteran being the focus. The Assistant Chief Nurse assists with overseeing the timely and accurate completion… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …+ Participate in interdisciplinary case rounds, quality improvement initiatives, and utilization review processes. + Support members during transitions of ... Position is On-Site The Behavioral Health Nurse - Managed Care is responsible for coordinating,...+ Experience in a managed care, case management, or utilization review setting + Strong understanding of… more
- CVS Health (Tallahassee, FL)
- …with transferring patients to lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC recognized accreditation preferred. + ... is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management...**Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in… more
- MyFlorida (Port Saint Lucie, FL)
- REGISTERED NURSE Date: Aug 6, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... . Requisition No: 856173 Agency: Veterans Affairs Working Title: REGISTERED NURSE Pay Plan: Career Service Position Number: 50453000 Salary: $67,742.74 Posting… more
- Molina Healthcare (Tampa, FL)
- …1-3 years Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and ... outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/ medical reviews of previously denied… more