• Clinical Registered Nurse…

    Sharecare (Tallahassee, FL)
    …cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also responsible for early identification of those ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Clinical Registered Nurse has the responsibility for supporting the goals and… more
    Sharecare (05/10/25)
    - Related Jobs

  • Utilization Review Clinician…

    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. Candidates must be licensed and located in...abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with… more
    Centene Corporation (05/10/25)
    - Related Jobs

  • Utilization Review Clinician - ABA

    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 ... Treatment Plans required. Knowledge of ABA services and BH utilization review process required. Experience working with...plus holidays, and a flexible approach to work with remote , hybrid, field or office work schedules. Actual pay… more
    Centene Corporation (05/24/25)
    - Related Jobs

  • Care Manager RN - Remote

    Highmark Health (Tallahassee, FL)
    …Health **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... care services, application of criteria to ensure appropriate resource utilization , identification of opportunities for referral to a Health Coach/case management,… more
    Highmark Health (05/21/25)
    - Related Jobs

  • Transplant Care Nurse RN - Stem…

    Highmark Health (Tallahassee, FL)
    …**Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides ... to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, corporate, state, and… more
    Highmark Health (04/25/25)
    - Related Jobs

  • Investigator, SIU RN - Remote

    Molina Healthcare (FL)
    …abuse through the identification of aberrant coding and/or billing patterns through utilization review . * Incorporate leadership and communication skills to work ... care experience. **REQUIRED LICENSE, CERTIFICATION, ASSOCIATION** : Active, unrestricted State Registered Nursing ( RN ) license in good standing. **PREFERRED… more
    Molina Healthcare (04/12/25)
    - Related Jobs

  • Clinical Coding and OASIS Review Manager

    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
    BAYADA Home Health Care (05/17/25)
    - Related Jobs

  • Appeals and Grievances Clinical Specialist…

    Healthfirst (FL)
    …in clinical practice with experience in appeals & grievances, claims processing, utilization review or utilization management/case management. + Demonstrated ... This position is 100% Remote . We are hiring for the following schedules...understanding of Utilization Review Guidelines (NYS ART 44 and 49 PHL), InterQual,… more
    Healthfirst (05/29/25)
    - Related Jobs

  • Remote Case Manager

    Actalent (Orlando, FL)
    …HIPAA compliance. Additional Skills & Qualifications + Experience in care management, utilization review , or discharge planning. + HMO experience preferred. + ... Remote Case Manager Job Description This role involves...care settings, ensuring continuity and quality of care. The nurse will work collaboratively with care teams, patients, and… more
    Actalent (05/17/25)
    - Related Jobs

  • Consultant, Nurse Disability

    Lincoln Financial (Tallahassee, FL)
    …as indicated **What we're looking for** * 4 Year/Bachelor's Degree in Nursing * Registered Nurse License - Current, unrestricted license in the state where the ... **Alternate Locations:** Work from Home **Work Arrangement:** Remote : Work at home employee **Relocation assistance:**...Trauma , Disability, Workman's comp or case management or Utilization review **Application Deadline** **What's it like… more
    Lincoln Financial (04/30/25)
    - Related Jobs