- 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)
- 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)
- …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
- 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 ... be located in eastern or central time zone with experience in utilization management .** **Education/Experience:** Requires Graduate of an Accredited School… more
- Actalent (Orlando, FL)
- …to validate the necessity and setting of care. Essential Skills + Proficiency in utilization management and utilization review + Experience with Interqual ... + Expertise in medical, acute care, concurrent review, and prior authorization + Knowledge of managed care...ER, Med-Surge, PACU, etc. + Strong multitasking and time management abilities. + Quick learner with a go-with-the-flow attitude.… more
- Humana (Tallahassee, FL)
- …to helping people achieve their best health. Humana CarePlus is seeking a Pre- Authorization Nurse who reviews prior authorization requests for appropriate ... working with CMS Guidelines, MCG and/or InterQual guidelines. + 2+ years of Utilization Management (UM), Pre-Auth, and/or other managed care review experience. +… more