• Clinical Reviewer , Nurse

    Evolent (Tallahassee, FL)
    …Join a mission with a company behind it. **What You'll Be Doing:** As a Clinical Reviewer , Nurse , you will be a key member of the utilization management team. We ... providing better health outcomes. **Collaboration Opportunities:** As a Clinical Reviewer , Nurse , you will routinely interact with...You Will Be Doing:** + Functions in a clinical review capacity to evaluate all cases, which do not… more
    Evolent (08/19/25)
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  • Clinical Reviewer , Nurse -Surgery

    Evolent (Tallahassee, FL)
    …for the mission. Stay for the culture. **What You'll Be Doing:** As a Clinical Reviewer , Nurse , you will be a key member of the utilization management team. ... providing better health outcomes. **Collaboration Opportunities:** As a Clinical Reviewer , Nurse , you will routinely interact with...You Will Be Doing:** + Functions in a clinical review capacity to evaluate all cases, which do not… more
    Evolent (08/19/25)
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  • Clinical Dispute Reviewer

    Zelis (St. Petersburg, FL)
    …maintain bill review content, including but not limited to DRG Reviewer Rationales, DRG Clinical Validation Policies, CCR Review Guidelines and Templates, ... of facility and provider disputes as they relate to DRG validation, itemized bill review , and/or clinical claim review Expert Claim Review . They will… more
    Zelis (08/20/25)
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  • UM Clinical Reviewer

    Centers Plan for Healthy Living (Margate, FL)
    …For Healthy Living is currently accepting applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works ... their home to improve their quality of life. Utilization Management Clinical Reviewer will assess and process all authorization requests to determine medical… more
    Centers Plan for Healthy Living (07/15/25)
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  • Utilization Review Nurse

    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
    Actalent (08/21/25)
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  • Nurse Practitioner w/peds/newborn bilingual…

    CenterWell (Plant City, FL)
    …part of our caring community and help us put health first** The Nurse Practitioner applies advanced education and clinical competencies to achieve optimal patient ... outcomes. The Nurse Practitioner works on problems of diverse scope and...leadership. + Meets with RMD about quality of care, review of outcome data, policy, procedure and records issues.… more
    CenterWell (07/11/25)
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  • Utilization Management Nurse

    Actalent (Sunrise, FL)
    Actalent is hiring a Utilization Management Nurse ! Job Description The Utilization Management Nurse (UMN) collaborates closely with the interdisciplinary team to ... in complex cases, develops internal processes, and educates physicians on utilization review issues. The role involves managing continuity of care, ensuring smooth… more
    Actalent (08/21/25)
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  • Behavioral Health Nurse - Managed Care

    DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
    Position is On-Site The Behavioral Health Nurse - Managed Care is responsible for coordinating, monitoring, and delivering behavioral health services within a ... in interdisciplinary case rounds, quality improvement initiatives, and utilization review processes. + Support members during transitions of care, including… more
    DOCTORS HEALTHCARE PLANS, INC. (08/24/25)
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  • Registered Nurse Care Manager Weekends

    AdventHealth (Altamonte Springs, FL)
    …patient and involved care givers (as permitted by the patient) as well as a review of the current and past inpatient and outpatient medical record in the Initial ... updates, as needed. + Actively participates in daily Multidisciplinary Rounds to review progression of care and discharge plan for all assigned patients. Proactively… more
    AdventHealth (08/07/25)
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  • Transition of Care Associate - Licensed Practical…

    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 ... Qualifications** + Candidate must have an active and unrestricted Compact Licensed Practical Nurse (LPN) License in state of residence + 3+ years of Licensed… more
    CVS Health (08/27/25)
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