• Registered Nurse

    MTC (Graceville, FL)
    …chance to make a difference every day! Are you a dedicated and skilled RN looking for a meaningful opportunity to provide exceptional care? We're hiring passionate ... forms as appropriate. + Practice basic cost containment and utilization management for inmate care and facility operations. +...HIPAA rules. + Accurately and promptly chart medical care. Review medical files to determine all provided services are… more
    MTC (12/18/25)
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  • Clinical Reviewer , Nurse (Medical…

    Evolent (Tallahassee, FL)
    …the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
    Evolent (12/10/25)
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  • ECR Dispute Reviewer

    Zelis (St. Petersburg, FL)
    …clinical experience in a healthcare setting, with a strong background in clinical review , utilization management, or quality assurance. + Extensive knowledge of ... interests that shape who you are. Position Overview The ECR Dispute Reviewer is responsible for conducting comprehensive clinical reviews of medical records, claims,… more
    Zelis (12/17/25)
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  • SNF Utilization Management RN…

    Humana (Tallahassee, FL)
    …an impact** **Use your skills to make an impact** **Required Qualifications** + **​Licensed Registered Nurse ( RN )** in the (appropriate state) with no ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...in an acute care setting + Previous experience in utilization management/ utilization review for a… more
    Humana (12/12/25)
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  • Utilization Review Team Lead

    BayCare Health System (St. Petersburg, FL)
    … Management or 6 years of clinical nursing **Certifications and Licensures:** + Required RN ( Registered Nurse ) + Preferred ACM (Case Management) + Preferred ... trust, dignity, respect, responsibility and clinical excellence. **The Team Lead Utilization Review responsibilities include:** + Directing and coordinating the… more
    BayCare Health System (11/12/25)
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  • Care Review Clinician ( RN )

    Molina Healthcare (Orlando, FL)
    For this position we are seeking a ( RN ) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity ... (Team will work on set schedule) Looking for a RN with experience with appeals, claims review ,...or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must… more
    Molina Healthcare (11/23/25)
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  • Care Review Clinician ( RN )

    Molina Healthcare (FL)
    …authorization, managed care, or equivalent combination of relevant education and experience. * Registered Nurse ( RN ). License must be active and unrestricted ... emergency room. Preferred Experience Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual /… more
    Molina Healthcare (12/13/25)
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  • RN Case Manager PRN

    HCA Healthcare (Orange Park, FL)
    **Description** **Introduction** Do you have the PRN career opportunities as a ** Registered Nurse ( RN ) Case Manager** you want with your current employer? We ... expertise! **Job Summary and Qualifications** We are seeking a Registered Nurse ( RN ) Case Manager...this PRN position. + Certification in Case Management or Utilization Review is preferred. + InterQual experience… more
    HCA Healthcare (12/03/25)
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  • RN Case Manager Part Time

    HCA Healthcare (Tallahassee, FL)
    …active FL RN license required within90 days of hire** + **Advanced Practice Registered Nurse license is acceptable for position if current and compliant** + ... supporting a balance of optimal care and appropriate resource utilization . The RN CM Care Coordinator will...**Certification in Case Management, Nursing, or Utilization Review , preferred** + **Three years of… more
    HCA Healthcare (11/10/25)
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  • RN Case Manager Evenings

    HCA Healthcare (Tallahassee, FL)
    …active FL RN licenserequiredwithin90 days of hire** + **Advanced Practice Registered Nurse license is acceptable for position if current and compliant** ... supporting a balance of optimal care and appropriate resource utilization . The RN CM Care Coordinator will...+ **Certification in Case Management, Nursing, or Utilization Review , preferred** + **Three years of… more
    HCA Healthcare (11/10/25)
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