- Humana (Tallahassee, FL)
- …a team **Preferred Qualifications** + Bachelor's degree + Previous experience in prior authorization , claims, and/or utilization management in healthcare, ... a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… 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
- University of Miami (Miami, FL)
- …Review Case Manager RN - Full Time The University of Miami is currently seeking a Prior Authorization Nurse Case Manager. The incumbent purose is to conduct ... reviews for medical necessity and identify the need for authorization . The nurse coordinates with the healthcare...Adhere and perform timely prospective reviews for services requiring prior authorization + Follows the authorization… more
- Centene Corporation (Tallahassee, FL)
- …(BH) and/or autism spectrum disorder needs and clinical standards + Performs prior authorization reviews related to BH to determine medical appropriateness ... applied behavioral analytics (ABA). Additional Details: * Department: Behavioral Health Utilization Management * Business Unit: Corporate / Florida * Schedule:… 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
- Veterans Affairs, Veterans Health Administration (Gainesville, FL)
- …a bachelor's level degree in Nursing may have opportunity to become registered as a nurse with a state licensing board prior to completion of the bridge program. ... North Florida/South Georgia Veterans Health System (NF/SG VAHS) is recruiting for a Registered Nurse Care Coordinator to work in the Office of Community Care at the… more
- Molina Healthcare (Miami, 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
- Prime Therapeutics (Tallahassee, FL)
- …outreach and review of medical records to audit authenticity of provider response during Prior Authorization and reporting results to client. + Assists with the ... cardholders, and pharmacies. + Escalates medical exception requests to nurse , pharmacist or physician on the utilization ...to nurse , pharmacist or physician on the utilization review clinical team when further review is necessary.… more