• Utilization Review Clinician

    Monte Nido (Miami, FL)
    …while providing the opportunity for people to realize their healthy selves. ** Utilization Review Clinician** **Monte Nido** **Remote** **Monte Nido has been ... within an intimate home setting. We are seeking a Utilization Review Clinician to join our team...with billing regarding billing/claims issues and status of single case agreements as needed. + Effectively communicate with program… more
    Monte Nido (09/06/25)
    - Related Jobs

  • Manager, Case Management, RN

    Carnival Cruise Line (Miami, FL)
    …guests annually and employing over 160,000 crew members. **Essential Functions:** + ** Case Management Oversight** + Manage and review cases, including those ... This role reports to the Senior Manager of Case Management and oversees the daily operations of...Manager also escalates high-risk cases, conducts care coordination and utilization reviews. Operationally, the role supports shipboard medical teams,… more
    Carnival Cruise Line (08/29/25)
    - Related Jobs

  • Medical Claim Review Nurse…

    Molina Healthcare (Tampa, FL)
    …SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years ... hours 6 AM to 6 PM (Team will work on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing… more
    Molina Healthcare (09/06/25)
    - Related Jobs

  • RN - Care Management PRN

    AdventHealth (Land O' Lakes, FL)
    …for one another and respect for each persons unique contributions, provides utilization review care that is non-judgmental and non-discriminatory. Consider ... effective time frames on a specific group of patients.The Case Manager is responsible for utilization reviews...(2) years of hospital nursing experience .Current license of registered nurse in Florida or licensure from… more
    AdventHealth (08/07/25)
    - Related Jobs

  • RN Clinical Manager, Home Health

    CenterWell (Land O' Lakes, FL)
    …action through the utilization of Performance Improvement principles. + Responsible for review of the appropriate number of Case Managers and clinical staff ... clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the...School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR.… more
    CenterWell (09/30/25)
    - Related Jobs

  • RN Lead, Healthcare Services

    Molina Healthcare (FL)
    …and at least 2 years of managed care experienced in utilization management * Registered Nurse ( RN ) ONLY if required by state contract, regulation or ... skills. * Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications * Registered Nurse ( RN ). License must be active and… more
    Molina Healthcare (09/26/25)
    - Related Jobs

  • RN - Care Manager

    AdventHealth (Zephyrhills, FL)
    …care. **The expertise and experiences you'll need to succeed:** Associates Degree Nursing or RN Diploma degree Registered Nurse ( RN ) Two (2) ... Care) Premium shopping outlets **The role you'll contribute:** The RN Care Manager in collaboration with the patient/family, social...a hospital setting + One (1) year experience of utilization review This facility is an equal… more
    AdventHealth (09/26/25)
    - Related Jobs

  • Home Care Supervisor, RN

    BayCare Health System (Bradenton, 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... Case Manager on initial Plan of Care review with a focus on quality, utilization … more
    BayCare Health System (08/22/25)
    - Related Jobs

  • RN Care Manager PRN

    AdventHealth (Zephyrhills, FL)
    …Qualifications **The expertise and experiences you'll need to succeed:** Associates Degree Nursing or RN Diploma degree Registered Nurse ( RN ) Two (2) ... attractions (Orlando & Tampa theme parks) **The role you'll contribute:** The RN Care Manager in collaboration with the patient/family, social workers, nurses,… more
    AdventHealth (09/06/25)
    - Related Jobs

  • Director Case Management

    HCA Healthcare (Kissimmee, FL)
    …Master's degree in Nursing, Health Administration, or Business Administration, preferred + Either Registered Nurse ( RN ) licensure , Licensed Clinical Social ... interdisciplinary teams and external stakeholders. The Director is a registered nurse with responsibility for all operational...growth, we encourage you to apply for our Director Case Management opening. We promptly review all… more
    HCA Healthcare (09/19/25)
    - Related Jobs