- Molina Healthcare (Miami, FL)
- JOB DESCRIPTION **Job Summary** Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal ... nursing experience, including at least 1 year of utilization review , medical claims review , long-term...equivalent combination of relevant education and experience. + Registered Nurse (RN). License must be active and unrestricted in… more
- Actalent (Orlando, FL)
- Remote Clinical Review Nurse - Prior Authorization Location: Must be located in Central or Eastern time zones Employment Type: Full‑Time About the Role We ... are seeking an experienced Registered Nurse to join our team within a leading Managed...a leading Managed Care Organization. This role is fully remote and focuses on reviewing clinical documentation to determine… more
- CVS Health (Tallahassee, FL)
- …do it all with heart, each and every day. **Position Summary** **This is a remote work from home role anywhere in the US with virtual training.** American Health ... Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS...**Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in… more
- Datavant (Tallahassee, FL)
- …+ 3+ years of CDI experience + 3+ years of clinical experience in an academic medical center + Registered Nurse license, Bachelor's degree in Nursing + CCDS or ... you will play a pivotal role in elevating the impact of our medical record documentation. You will conduct daily evaluations and engage in direct communication… more
- Highmark Health (Tallahassee, FL)
- …to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, corporate, state, and ... RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC) or WV or DE or...Working knowledge of pertinent regulatory and compliance guidelines and medical policies + Ability to multi task and perform… 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 ... policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate,...medical necessity and appropriateness of services using clinical review criteria. + Accurately documents all review … more
- AccentCare, Inc. (Miami, FL)
- … / RN Team Director MUST be Bilingual in English and Spanish MIN 2 yrs NURSE LEADERSHIP and 5 yrs RN experience Remote /Virtual Position : No Coverage Area: North ... Overview Registered Nurse / RN Team Director, Hospice Location: Miami...+ Three+ years' experience in hospice, home health, general medical surgery, oncology, or patient population-specific nursing (ie, geriatrics,… more
- Battelle Memorial Institute (Eglin AFB, FL)
- …Research and Analytics (HRA) business line is seeking a highly motivated, full-time ** Nurse Case Manager** to join our team in support of our government customer, ... and their families, ensuring comprehensive support for those who serve. As a Nurse Case Manager, you will contribute to impactful research and analytics that drive… more
- AccentCare, Inc. (Miami, FL)
- Overview Clinical Manager Inpatient Hospice Center, Registered Nurse Location: North Shore Hospital, Miami, FL Position Type: Full-Time Remote /Virtual Position: ... Find Your Passion and Purpose as a Clinical Manager Inpatient Hospice Center, Registered Nurse Salary: $85,000 - $93,000 / year Offer Based on Years of Experience… more
- University of Miami (Miami, FL)
- …or staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . Up to ... Miami Hospital + This is an onsite position. Not remote . + Provides for patients' personal hygiene by giving...and equipment. + Reports patient conditions to the assigned nurse to ensure professional assessment. + Measures and records… more