- Actalent (Sunrise, FL)
- Utilization Management Nurse !Job Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing service authorization requests to ensure ... staff to direct utilization and capture data effectively. Responsibilities + Review prior authorization requests for medical necessity and appropriateness, utilizing… more
- CVS Health (Tallahassee, FL)
- …visit, inpatient, skilled nursing, or rehabilitative stay. Under the direction of a Registered /Licensed RN , the TOC Coach ensures the member experiences a ... or changes in condition to be transitioned back to RN + Complete post discharge call and required assessments...who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current… more
- CenterWell (Tallahassee, FL)
- …community and help us put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers in reviewing actual and proposed ... medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part...on excellent service to others. **Required Qualifications** + Active RN license + Possession of or ability to obtain… more
- CenterWell (Tallahassee, FL)
- …and the healthcare industry as a whole. Conviva Care Solutions is seeking a RN who will collaborate with other health care givers in reviewing actual and proposed ... medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part...skills to make an impact** **Role Essentials** + Active RN license + Possession of or ability to obtain… more
- CenterWell (Tallahassee, FL)
- …off-days during the week.** The **Clinical Care Coordinator/Care Manager, Telephonic Nurse ** helps to ensure optimal continuity of care for patients transitioning ... and under established performance criteria. This is a work-from-home telephonic nurse position **Essential Functions:** + Act as CenterWell Home Health… more
- Molina Healthcare (Miami, FL)
- **Job Summary** **_For this position we are seeking a ( RN ) Registered Nurse who must be licensed for the state of KENTUCKY or have a compact license._** ... Nursing experience, including hospital acute care/medical experience (STRONGLY DESIRED)** + ** Registered Nurse with Claims and CIC coding experience (STRONGLY… more
- Fresenius Medical Center (Stuart, FL)
- …Report any significant information and/or change in patient condition directly to the registered nurse or supervisor. + Observe patient and conduct machine ... policy. Report any change or unusual findings to the registered nurse or supervisor. + Perform and...+ Monitors patients performing self-care under the supervision of RN . **Staff Related** + Assists in training of applicable… more
- CenterWell (Clearwater, FL)
- …+ Graduate of an accredited School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR. + Valid driver's license, auto insurance ... community and help us put health first** + The ** RN Clinical Manager** coordinates and oversees all direct care...and reliable transportation. + Two years as a Registered Nurse in home health or hospice,… more
- BrightSpring Health Services (Gainesville, FL)
- …and + Must have completed post-secondary education coursework to facilitate licensure as a Registered Nurse ( RN ) + Must have healthcare management experience ... policies and procedures, state licensure and regulations, Medicaid, and Medicare standards, as well as state reimbursement regulations +...intellectually disabled individuals is preferred + Must be a Registered Nurse ( RN ) in good… more
- Humana (Tallahassee, FL)
- …in Nursing (BSN) or Bachelor's degree in any field or equivalent experience + Active unrestricted Registered Nurse ( RN ) license + 5 years or more of prior ... medical directors and leadership during Medicare and Medicaid LOB - Medicare Clinical Criteria Review (MCCR), Utilization Management Committee (UMC), Medical… more