• 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 ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
    Centene Corporation (09/18/25)
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  • Behavioral Health Utilization Review…

    Actalent (Sunrise, FL)
    Job Title: Behavioral Health Utilization Review NurseJob Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing requests ... reports on department activities as assigned. Essential Skills + Experience in utilization management , behavioral health, and mental health. + Proficiency in… more
    Actalent (10/02/25)
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  • Utilization Review Clinician

    Monte Nido (Miami, FL)
    …reviews. + Communicate emerging trends with insurance companies to Director of Utilization Management . + Maintain database of insurance company clinical care ... while providing the opportunity for people to realize their healthy selves. ** Utilization Review Clinician** **Monte Nido** ** Remote ** **Monte Nido has been… more
    Monte Nido (09/06/25)
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  • Dementia Care Navigator, RN

    Bluestone Physician Services (Tampa, 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 Degree in Social Work, Licensed Social… more
    Bluestone Physician Services (09/18/25)
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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 (09/13/25)
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  • Medical Claim Review Nurse ( RN )

    Molina Healthcare (Tampa, FL)
    …of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. ... state/federal regulations **REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:** Active, unrestricted State Registered Nursing ( RN ) license in good standing.… more
    Molina Healthcare (09/06/25)
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  • Appeals and Grievances Clinical Specialist…

    Healthfirst (FL)
    …Experience in clinical practice with experience in appeals & grievances, claims processing, utilization review or utilization management /case management . ... This position is 100% Remote . We are hiring for the following schedules...process + Additional duties as assigned Minimum Qualifications: + RN , LPN OR Dental Hygienist Preferred Qualifications: + Bachelors… more
    Healthfirst (10/02/25)
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  • Consultant, Nurse Disability I

    Lincoln Financial (Tallahassee, FL)
    …and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management preferred skills ... **Alternate Locations:** Work from Home **Work Arrangement:** Remote : Work at home employee residing outside...for** Education * 4 Year/Bachelor's Degree in Nursing * Registered Nurse License - Current, unrestricted license… more
    Lincoln Financial (10/01/25)
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  • Care Management Social Worker

    AdventHealth (Maitland, FL)
    **Care Management Social Worker AdventHealth PHSO Resources** **All the benefits and perks you need for you and your family:** + Benefits from Day One + Paid Days ... we are even better. **Schedule: Monday-Friday** **Shift** : 8:00AM-5:00PM **Location:** Remote **The role you'll contribute:** Promotes the psychosocial health and… more
    AdventHealth (09/09/25)
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  • Hybrid Bilingual Manager, Care Integration Team

    CenterWell (Tampa, FL)
    …a part of our caring community and help us put health first** The Manager Care/Case Management in **Tampa area (** **_this is not a remote position_** **)** is ... managing populations and coordinating care to reduce acute and post-acute care utilization . The Manager role is hybrid with travel requirements to preferred… more
    CenterWell (08/09/25)
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