- CVS Health (Tallahassee, FL)
- …care. + Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse ( RN ) with at least 1 year of experience ... in a hospital setting. + A Registered Nurse that holds an active, unrestricted...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
- Centene Corporation (Tallahassee, FL)
- …Family Therapist (LMFT) required or + Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State ... Complies with all policies and standards. **This is a remote position. Ideal candidate will be located in eastern...abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with… more
- Centene Corporation (Tallahassee, FL)
- …Family Therapist (LMFT) required or + Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State ... perspective on workplace flexibility. NOTE: This is a fully remote role. Preference will be given to applicants who...Treatment Plans required. Knowledge of ABA services and BH utilization review process required. Experience working with… more
- CVS Health (Tallahassee, FL)
- …of varied UM ( utilization management) experience within an inpatient, concurrent review or prior authorization. + Remote work experience. **Education** + ... demonstrated ability to make thorough, independent decisions using clinical judgement. + A Registered Nurse that must hold an unrestricted license in their state… more
- AdventHealth (Orlando, FL)
- …of experience in home health + 2 years of experience in management position. + Registered Nurse State Licensure and/or Compact State Licensure + Cert for Oasis ... **Population Health Case Manager ( RN ) AdventHealth Home Health** **All the benefits and...through Friday 8:00 am to 5:00 pm **Location:** Virtual Remote near 602 COURTLAND ST, Orlando, FL, 32804 **The… more
- CenterWell (Tallahassee, FL)
- …community and help us put health first** Conviva Care Solutions is seeking a RN who will collaborate with other health care givers in reviewing actual and proposed ... medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part...on excellent service to others. **Required Qualifications** + Active RN license + Possession of or ability to obtain… more
- CenterWell (Tallahassee, FL)
- …and the healthcare industry as a whole. Conviva Care Solutions is seeking a RN who will collaborate with other health care givers in reviewing actual and proposed ... medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part...skills to make an impact** **Role Essentials** + Active RN license + Possession of or ability to obtain… more
- Molina Healthcare (Tampa, FL)
- **JOB DESCRIPTION** For this position we are seeking a ( RN ) Registered Nurse who must be licensed for the state they reside This position will support ... Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support,… more
- BAYADA Home Health Care (Orlando, FL)
- …with an industry leader. Apply now for immediate consideration. OASIS Review , Utilization Review , Quality Assurance, Remote , Home Health Coding, Coder, ... immediate opening for a **Full Time,** OASIS and Coding Review Manager with OASIS and Coding certification to work...Manager with OASIS and Coding certification to work remotely. RN , PT, OT, and SLP's with certifications will be… more
- Prime Therapeutics (Tallahassee, FL)
- …Patient Programs. **Education & Experience** + Associates - Nursing + Bachelors - Nursing + RN - Registered Nurse , State and/or Compact State Licensure - ... for work visa or residency sponsorship. **Additional Qualifications** + Registered Nurse ( RN ). + 5...Experience in managed care, specialty drugs, care management and utilization review . + Meets Credentialing criteria. +… more