- Molina Healthcare (St. Petersburg, FL)
- …role must complete courses required to obtain licensure in all states. + Utilization Review Lead responsibilities also include but not limited to, collaborate ... timely completion. + Actively participates in the Department auditing program to review and communicate findings with staff and identify opportunities for improved… more
- University of Miami (Miami, FL)
- …please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . Utilization Review Case Manager RN - Full ... University of Miami is currently seeking a Prior Authorization Nurse Case Manager. The incumbent purose is to conduct...incumbent purose is to conduct initial chart reviews for medical necessity and identify the need for authorization. The… more
- CVS Health (Tallahassee, FL)
- …advocates for members who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current case management and ... functioning in the community. - Utilizes weekly and daily reporting to identify utilization for the purpose of reducing Emergency Department Utilization and… more
- HCA Healthcare (Orange Park, FL)
- …is required for this PRN role.** + Certification in Case Management or Utilization Review is preferred. + InterQual experience is preferred. HCA Florida ... you have the PRN career opportunities as a **Registered Nurse (RN) Case Manager** you want with your current...colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no… more
- HCA Healthcare (Jacksonville, FL)
- …is required for this PRN role. + Certification in Case Management or Utilization Review is preferred. + InterQual experience is preferred. Memorial Hospital ... you have the PRN career opportunities as a **Registered Nurse (RN) Case Manager** you want with your current...colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no… more
- HCA Healthcare (Ocala, FL)
- …required + 4 year Bachelor Degree preferred + Certification in Case Management or Utilization Review preferred + 1 year experience in acute hospital with ... and retirement of our colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no cost or for a low… more
- HCA Healthcare (Kissimmee, FL)
- …driven processes, for the appropriate level of care, patient status and resource utilization + Evaluates admissions for medical necessity using approved criteria ... colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no...supporting a balance of optimal care and appropriate resource utilization . What you will do in this role: +… more
- AdventHealth (Deland, FL)
- …education to nurses, physicians and the interdisciplinary team on issues related to utilization of resources, medical necessity, CMS CoP for Discharge Planning ... (as permitted by the patient) as well as a review of the current and past inpatient and outpatient...Associate's degree Nursing or RN Diploma degree + Registered Nurse (RN) + Two (2) years of medical… more
- HCA Healthcare (Orange Park, FL)
- …Degree, or Registered Nurse Diploma + APRN preferred + 3 years Medical /Surgical Nursing required + 1 year in Quality Improvement required + BLS required + ... level of integrity. The Program Coordinator is also responsible for utilization , community outreach, patient advocacy, staff and physician education and marketing… more
- BayCare Health System (Bradenton, FL)
- …bodies within the area of responsibility. + Ensure quality assurance program and utilization review is followed in accordance with Home Care protocol. + ... amazing career growth opportunities. + Weekend shift differential + Medical benefits (Health, Dental, Vision) + Paid time off...Participates with Case Manager on initial Plan of Care review with a focus on quality, utilization … more