• Utilization Review Clinician - Behavioral…

    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...in eastern or central time zone with experience in utilization management .** **Education/Experience:** Requires Graduate of an… more
    Centene Corporation (07/31/25)
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  • Utilization Management Nurse…

    CVS Health (Tallahassee, FL)
    …This is a fully remote role open to candidates with an active RN licensure in the state in which they reside. Working schedule is Monday-Friday, 8am-5pm with ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and knowledge in… more
    CVS Health (07/22/25)
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  • Utilization Management Nurse…

    CVS Health (Tallahassee, FL)
    …and work schedule may include weekends, holidays, and evening hours._ **UM Nurse Consultant** Fully Remote - WFH **Position Summary** + Utilizes clinical ... and external constituents in the coordination and administration of the utilization /benefit management function. **Required Qualifications** + 3+ years of… more
    CVS Health (07/30/25)
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  • Utilization Management Nurse

    CenterWell (Tallahassee, FL)
    …+ Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... as a whole. Conviva Care Solutions is seeking a RN who will collaborate with other health care givers...procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous… more
    CenterWell (08/02/25)
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  • Utilization Management Nurse…

    CVS Health (Tallahassee, FL)
    …**Position Summary** **Fully remote with requirement to reside in Florida.** + Utilization Management is a 24/7 operation and the work schedule may include ... **Required Qualifications** + Must have active, current and unrestricted RN licensure in Florida + Must reside in Florida...in Florida + 3+ years of clinical experience + Utilization Management is a 24/7 operation and… more
    CVS Health (07/30/25)
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  • 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 ... depending on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field **SKILLS** + Working knowledge of… more
    Highmark Health (07/12/25)
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  • Clinical Appeals Nurse ( RN )

    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 ... Chief Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. +… more
    Molina Healthcare (08/02/25)
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  • Dementia Care Navigator, RN

    Bluestone Physician Services (Wesley Chapel, FL)
    …with primary care teams to ensure high quality team-based care + Use utilization management tools to facilitate appropriate transitional care management ... with providers to identify high risk patients Qualifications : Education/Certification/Experience + Registered Nurse or Licensed Social Worker + 3-5 years of… more
    Bluestone Physician Services (07/24/25)
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  • Disease Management Nurse…

    Sharecare (Tallahassee, FL)
    …appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants ... learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting...with disabilities to perform the essential functions. + Current Registered Nurse multi-state compact license in the… more
    Sharecare (07/12/25)
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  • Infusion Referral Nurse - REMOTE

    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. + Experience in managed care, specialty drugs, care management and utilization review. + Meets Credentialing… more
    Prime Therapeutics (07/24/25)
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