- Actalent (Orlando, FL)
- …successful completion of cases. Essential Skills + Experience in utilization management , concurrent review, prior authorization , utilization review, ... + Active Compact RN License, Compact LPN is okay too + Utilization Management /Concurrent Review experience. + ICU/ER experience. + Strong communication… more
- 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)
- Actalent is hiring a Utilization Management Nurse! Job Description The Utilization Management Nurse (UMN) collaborates closely with the interdisciplinary ... safety, and appropriate length of stay. Responsibilities + Review prior authorization requests for medical necessity and...activities as assigned. Essential Skills + Clinical review + Utilization review + Utilization management … more
- CVS Health (Tallahassee, FL)
- … management ) experience within an inpatient, concurrent review or prior authorization . + Remote work experience. **Education** + Associate degree ... is URAC accredited in Case Management , Disease Management and Utilization Management . AHH...day working with providers to secure additional information for prior authorization review. This candidate will utilize… more
- CVS Health (Tallahassee, FL)
- …with Microsoft Office Applications (Outlook, Teams, Excel) **Preferred Qualifications** + Prior authorization utilization experience preferred + Outpatient ... and external constituents in the coordination and administration of the utilization /benefit management function. **Required Qualifications** + 3+ years of… more
- CVS Health (Tallahassee, FL)
- …of relevant experience in Nursing. + At least 1 year of Utilization Management experience in concurrent review or prior authorization . + Strong ... 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
- Molina Healthcare (Jacksonville, FL)
- …include those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and ... **JOB DESCRIPTION** **Job Summary** Molina Pharmacy Services/ Management staff work to ensure that Molina members...initiatives under the direction of leadership. + Monitors drug utilization and assists leadership team in understanding quality and… more
- CVS Health (Tallahassee, FL)
- …every day. **Position Summary** **Fully remote with requirement to reside in Florida.** + Utilization Management is a 24/7 operation and the work schedule may ... in Florida + 3+ years of clinical experience + Utilization Management is a 24/7 operation and...(Teams, Outlook, Word, Excel, etc.) **Preferred Qualifications** + Previous prior authorization experience + Prefer RN FL… more
- Monte Nido (Miami, FL)
- …all authorizations for designated programs & departments including single case agreements, prior authorization , continued stay, change in level of care, ... while providing the opportunity for people to realize their healthy selves. ** Utilization Review Clinician** **Monte Nido** **Remote - EST or CST hours** **Monte… more
- Centene Corporation (Tallahassee, FL)
- …in applied behavioral analytics (ABA). Additional Details: * Department: Behavioral Health Utilization Management * Business Unit: Corporate / Florida * ... (BH) and/or autism spectrum disorder needs and clinical standards + Performs prior authorization reviews related to BH to determine medical appropriateness… more
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