• Appeals Nurse

    Evolent (Tallahassee, FL)
    …and accomplishments. **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to ... and as an RN - **Required** + Minimum of 5 years in Utilization Management , health care Appeals , compliance and/or grievances/complaints in a quality… more
    Evolent (12/24/25)
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  • RN Clinical Appeals Nurse Remote

    Molina Healthcare (Jacksonville, FL)
    …be required. * Serves as a clinical resource for utilization management , chief medical officer, physicians, and member/provider inquiries/ appeals . * Provides ... JOB DESCRIPTION **Job Summary** The RN Clinical Appeals Nurse provides support for internal...officer on denial decisions. * Resolves escalated complaints regarding utilization management and long-term services and supports… more
    Molina Healthcare (01/02/26)
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  • Clinical Registered Nurse…

    Cognizant (Tallahassee, FL)
    …background - Registered Nurse (RN) + 2-3 years combined clinical and/or utilization management experience with managed health care plan + 3 years' experience ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations + Experience in utilization management to include Clinical Appeals… more
    Cognizant (12/23/25)
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  • Behavioral Health Nurse - Managed Care

    DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
    …in utilization of resources, avoidable days/denials. Works in collaboration with Appeals Management /Medical Director in the appeals process. + ... it pertains to patient admission/safe discharge. + Participates in utilization management initiatives/opportunities for improvement through departmental… more
    DOCTORS HEALTHCARE PLANS, INC. (01/01/26)
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  • Medical Director (NV)

    Molina Healthcare (Tampa, FL)
    …of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies ... the most appropriate care at the most effective setting. *Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and… more
    Molina Healthcare (11/21/25)
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  • Medical Director - Medical Oncology

    Elevance Health (Miami, FL)
    **Clinical Operations Medical Director** **Medical Oncology** **Carelon Medical Benefit Management ** **Virtual** : This role enables associates to work virtually ... proud member of the Elevance Health family of companies, Carelon Medical Benefits Management , formerly AIM Specialty Health, is a benefit- management leader in… more
    Elevance Health (12/04/25)
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  • Care Review Clinician (RN)

    Molina Healthcare (Orlando, FL)
    …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is...set schedule) Looking for a RN with experience with appeals , claims review, and medical coding. JOB DESCRIPTION Job… more
    Molina Healthcare (11/23/25)
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