- CVS Health (Tallahassee, FL)
- …Qualifications** + Must reside in EST zone + 3+ years of experience as a Registered Nurse + 3+ years of clinical experience required + Must have active ... reside in EST time zone.** This is a full-time remote position. + Utilizes clinical experience and skills in...able to work Monday through Friday, 8:00am to 5:00pm. Utilization management is a 24/7 operation. Work… more
- Humana (Tallahassee, FL)
- …+ Minimum 3 years of experience in NCQA Health Plan Accreditation and/or Utilization Management + Exceptional attention to detail. + Demonstrated excellent time ... + Expertise on NCQA accreditation standards, especially related to Utilization Management and/or Behavioral Health; MED-Deeming accreditation standards… 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 ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- Highmark Health (Tallahassee, FL)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... required depending on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field + Certification in Case … more
- Bluestone Physician Services (Sarasota, 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
- Elevance Health (FL)
- …Service Coordinator - RN Telehealth** _Location:_ While this position is fully remote , candidate must reside in the tri-state area (NY, NJ, or CT) and within ... 50 miles of a PulsePoint. The **LTSS Service Coordinator - RN Telehealth** is responsible for overall management of member's case within the scope of licensure;… more
- Molina Healthcare (FL)
- …Practical Nurse in good standing. **Preferred Education** Completion of an accredited Registered Nurse ( RN ) Program or a bachelor's degree in Nursing. ... contained in the delegation agreement. **KNOWLEDGE/SKILLS/ABILITIES** The Delegation Oversight Nurse is responsible for ensuring that Molina Healthcare's UM… more
- ChenMed (Miami, FL)
- …in area of specialty required; Master's degree in Nursing required. + Valid, active Registered Nurse license required + For NPs: Board certification by AANP or ... PRN is responsible for diagnostic patient care primarily through virtual, remote consultation via video conference or telephone. Providing on-call coverage, the… more
- Community Health Systems (Sarasota, FL)
- (Full-Time, Remote ) The Clinical Review Analyst is a professionally licensed nurse /LPN who is responsible for effectively managing the denial/appeal process via ... High School Diploma; Nursing Degree + License/Registration/Certification: Must possess current RN /LPN licensure in state of Florida + Computer Skills: To perform… more
- Sharecare (Tallahassee, FL)
- …of the care enhancement program by providing telephonic care and resource utilization for members in an appropriate, efficient, and cost-effective manner while ... the health care team to support appropriate total healthcare management . RD colleague is supervised by an Operations Manager....will follow company policy to transfer call to an RN or appropriate colleague when member needs are outside… more
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