- Actalent (Sunrise, FL)
- …direct utilization and capture data effectively. Responsibilities + Review prior authorization requests for medical necessity and appropriateness, utilizing ... Utilization Management Nurse !Job Description The ...between the Medical Director, physicians, and office staff, resolving prior authorization issues. + Communicate denial determinations… more
- Actalent (Sunrise, FL)
- …satisfaction, safety, and appropriate length of stay. Responsibilities + Review prior authorization requests for medical necessity and appropriateness using ... Actalent is hiring a Utilization Management Nurse ! Job Description The...with the interdisciplinary team to perform reviews of service authorization requests, ensuring the utilization of appropriate… more
- CVS Health (Tallahassee, FL)
- …4 hours a day working with providers to secure additional information for prior authorization review. This candidate will utilize clinical skills to coordinate, ... ( utilization management) experience within an **outpatient** setting, concurrent review or prior authorization . + 5 years of a variety clinical experience… more
- CVS Health (Tallahassee, FL)
- …1 year of Utilization Management experience in concurrent review or prior authorization . + Strong decision-making skills and clinical judgment in independent ... high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant to join...+ Experience in a high-volume clinical call center or prior remote work environment. **Education** + Associate's degree in… more
- CVS Health (Tallahassee, FL)
- …with Microsoft Office Applications (Outlook, Teams, Excel) **Preferred Qualifications** + Prior authorization utilization experience preferred + Outpatient ... and work schedule may include weekends, holidays, and evening hours._ **UM Nurse Consultant** Fully Remote- WFH **Position Summary** + Utilizes clinical experience… more
- CVS Health (Tallahassee, FL)
- …of residence. + 3+ years of Nursing experience. Preferred Qualifications + Prior authorization utilization management/review experience preferred Outpatient ... and external constituents in the coordination and administration of the utilization /benefit management function. Required Qualifications + Registered Nurse in… more
- CVS Health (Tallahassee, FL)
- …Suite applications (Teams, Outlook, Word, Excel, etc.) **Preferred Qualifications** + Previous prior authorization experience + Prefer RN FL Compact license + ... **Fully remote with requirement to reside in Florida.** + Utilization Management is a 24/7 operation and the work... Prior experience working for a health plan or MCO… more
- Elevance Health (Miami, FL)
- …eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization , and post service requests. + Obtains intake ... ** Utilization Management Representative II** **Location:** This role enables...to screen basic and complex requests for precertification and/or prior authorization . + Verifies benefits and/or eligibility… more
- Centene Corporation (Tallahassee, FL)
- …services to ensure level of care and services are medically appropriate + Performs prior authorization reviews related to mental health and substance abuse to ... Analyzes BH member data to improve quality and appropriate utilization of services + Provides education to providers members...Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- Molina Healthcare (Tampa, FL)
- …benefits and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina ... + Processes requests within required timelines. + Refers appropriate prior authorization requests to Medical Directors. +...Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization… more
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