- Elevance Health (Tampa, FL)
- **Manager I Medical Management (Prior Authorizations) - Florida Medicare ** **Office Locations:** This role is based in Florida at either our Tampa or Miami ... an accommodation is granted as required by law._ The **Manager I Medical Management (Prior Authorizations)** is responsible for managing a team of clinicians charged… more
- Veterans Affairs, Veterans Health Administration (Miami, FL)
- …updates as needed. Supporting quality improvement activities based on CLC quality management data. Participating in ongoing survey readiness activities in ... and taking corrective action when notified by the CLC management team, charge nurse , or designee of...professionals. Supports colleagues through knowledge sharing to provide safe, quality nursing care. Questions clinical practices for… more
- CVS Health (Tallahassee, FL)
- …work outside of business hours, as needed. This position reports to the Potential Quality of Care (PQOC) nurse investigator team manager. This position is ... and/or provider issues. Applies specialized clinical knowledge to participate in quality improvement efforts to assess and enhance patient care. Collaborates with… more
- Humana (Tallahassee, FL)
- …a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied...need it. These efforts are leading to a better quality of life for people with Medicare ,… more
- CenterWell (Tallahassee, FL)
- …of our caring community and help us put health first** The **Denials Management Specialist** is responsible to respond to, monitor and analyze all governmental ... the dissemination of information. + Provides trended reports for operations and clinical management in order to improve performance, collaborates with and acts as a… more
- Humana (Tallahassee, FL)
- …they need, when they need it. These efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service ... people achieve their best health. Humana CarePlus is seeking a Pre-Authorization Nurse who reviews prior authorization requests for appropriate care and setting,… more
- Cleveland Clinic (Stuart, FL)
- …to helping patients stay on track with their health goals. As an Assistant Nurse Manager in Care Management , you will assist with day-to-day operations, utilize ... clinical expertise and understanding of care management and Medicare regulations, contribute to the...nursing . * Current state FL licensure as Registered Nurse (RN). * Professional certification as a Case Manager… more
- Molina Healthcare (Tampa, FL)
- …Medical Audit Specialist + Certified Case Manager + Certified Professional Healthcare Management + Certified Professional in Healthcare Quality + other ... For this position we are seeking a (RN) Registered Nurse who must be licensed for the state they...they reside This position will support Medical Review for Medicare and Marketplace request authorization. Strongly prefer candidates with… more
- Humana (Pinellas Park, FL)
- …the care management of pediatric members who reside in skilled nursing facilities, those requiring private duty nursing , and prescribed pediatric extended ... with a minimum of 2 years Pediatric acute care nursing experience **OR** Licensed Practical Nurse (LPN)...need it. These efforts are leading to a better quality of life for people with Medicare ,… more
- AdventHealth (Altamonte Springs, FL)
- … + Current valid State of Florida or multistate license as a Registered Nurse + 2 years of medical/ hospital nursing experience **Preferred qualifications:** + ... and Degrees without out-of-pocket tuition expense) *For eligible positions* + Nursing Clinical Ladder Program*For eligible positions* + Whole Person Well-being and… more