• RN Manager Care Management

    AdventHealth (Sebring, FL)
    …amongst staff Qualifications **The expertise and experiences you'll need to succeed:** . Registered Nurse : BSN or Social Worker: BSW Masters in related field. ... . 3 years in direct Care Management / Utilization Management experience in an...experience in an acute care setting. . State specific RN license if a nurse . . Licensed… more
    AdventHealth (06/23/25)
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  • Prior Authorization Nurse

    Actalent (Sunrise, FL)
    Utilization Management Nurse !Job Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing service authorization ... record Additional Skills & Qualifications + Current unrestricted Florida RN or LPN License. + Minimum of one year...experience. + Valid Florida Driver's License. + Knowledge of case management and utilization review… more
    Actalent (07/26/25)
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  • Clinical Appeals Nurse ( RN )

    Molina Healthcare (FL)
    **JOB DESCRIPTION** _For this position we are seeking a ( RN ) Registered Nurse who must be licensed for the state of UTAH or have a compact license._ _This ... Chief Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. +… more
    Molina Healthcare (07/20/25)
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  • Care Manager RN (Delaware)

    Highmark Health (Tallahassee, FL)
    …+ Experience in UM/CM/QA/Managed Care **LICENSES or CERTIFICATIONS** **Required** + United States Registered Nurse ( RN ) license + Delaware RN ... Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health… more
    Highmark Health (07/08/25)
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  • Home Care Supervisor, RN

    BayCare Health System (Lakeland, FL)
    …care goals. + Knowledge of regulatory standards appropriate to position. **Requirements:** + RN ( Registered Nurse ) License + Driver's License, State of ... Career with BayCare HomeCare as a Home Care Supervisor, RN . At BayCare, we are proud to be one...area of responsibility. + Ensure quality assurance program and utilization review is followed in accordance with Home Care… more
    BayCare Health System (07/24/25)
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  • Telephonic Nurse Case Manager

    ICW Group (Orlando, FL)
    …Discharge Planning, or Home Health preferred. **CERTIFICATES, LICENSES, REGISTRATIONS** Current unrestricted Registered Nurse ( RN ) or Licensed Vocational ... + Interfaces with external agencies in relation to the utilization review process including, Third-Party Payers, Insurance Companies and...Nurse (LVN) required. Certification in case management , rehabilitation nursing or a related… more
    ICW Group (06/18/25)
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  • Wound Care RN (Hospital)

    Trinity Health (Fort Lauderdale, FL)
    …people; adherence to established timelines; and professionalism. **Licensure/Certifications** + Must be a Registered Nurse ( RN ) licensed in the state of ... medical staff, Nurse Managers, Professional Practice, nursing staff, dietitians, and case managers in multiple hospitals to facilitate and provide basic WOC care… more
    Trinity Health (07/12/25)
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  • Manager Case Management

    HCA Healthcare (Ocala, FL)
    **Description** **Introduction** Do you have the career opportunities as a(an) Manager Case Management you want with your current employer? We have an exciting ... colleagues. Do you want to work as a(an) Manager Case Management where your passion for creating...and patient families. What qualifications you will need: + Registered Nurse + Associate Degree HCA Florida… more
    HCA Healthcare (06/21/25)
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  • Case Manager

    Select Medical (Miami, FL)
    …allotted time frame; assuring payments of hospital-based services meeting patient-related utilization management criteria, and implementation of safe and ... as part of the discharge planning process. + The primary job functions in Case Management include: + Clinical Interventions/Discharge Planning + Care Planning … more
    Select Medical (07/19/25)
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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 ... to identify high risk patients Qualifications : Education/Certification/Experience + Registered Nurse or Licensed Social Worker +...Licensed Social Worker + 3-5 years of experience in case /care management or care coordination + Experience… more
    Bluestone Physician Services (07/24/25)
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