- Cognizant (Tallahassee, FL)
- …background - Registered Nurse (RN) + 2-3 years combined clinical and/or utilization management experience with managed health care plan + 3 years' experience ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations + Experience in utilization management to include Clinical Appeals and… more
- Humana (Tallahassee, FL)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...in an acute care setting + Previous experience in utilization management / utilization review … more
- Centers Plan for Healthy Living (Margate, FL)
- …accepting applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works within a multidisciplinary ... care or support in their home to improve their quality of life. Utilization Management Clinical Reviewer will assess and process all authorization requests… more
- Evolent (Tallahassee, FL)
- …the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
- Community Health Systems (Naples, FL)
- …401k match & more available for Full and Part-Time roles **Job Summary** The Utilization Review Nurse - RN reviews hospital admissions, extended stays, ... Join us as a **Registered Nurse (RN) - Utilization Review...tools. + Collaborates with providers, care teams, and case management to ensure appropriate documentation, clinical justification, and status… more
- Elevance Health (Miami, FL)
- …Finder and follows up with provider on referrals given. + Refers cases requiring clinical review to a nurse reviewer ; and handles referrals for specialty ... ** Utilization Management Representative II** **Virtual:** This...+ Processes incoming requests, collection of information needed for review from providers, utilizing scripts to screen basic and… more
- Elevance Health (Jacksonville, FL)
- …precertification, prior authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer . + Responsible for the ... **Title: Utilization Management Representative I** **Virtual:** This...responsible for coordinating cases for precertification and prior authorization review . **How you will make an impact:** + Managing… more
- BayCare Health System (Tampa, FL)
- …2 years in Utilization Review or + Required 2 years in Case Management or + Required 3 years Registered Nurse + Preferred experience in Critical Care or ... of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior/RN responsibilities include:** + Functions… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …nursing experience, including behavioral/mental health + Experience in a managed care, case management , or utilization review setting + Strong understanding ... + Participate in interdisciplinary case rounds, quality improvement initiatives, and utilization review processes. + Support members during transitions of… more
- HCA Healthcare (Kissimmee, FL)
- …monitor and improve the patient flow program effectiveness as it relates to utilization review , resource management , and discharge planning and care ... leader to physicians and employees as it relates to utilization review , resource management , patient...30 days of employment start date + (RN) Registered Nurse + Associate Degree, or Bachelors Degree Preferred HCA… more