- Molina Healthcare (Jacksonville, FL)
- …of payment decisions. * Serves as a clinical resource for utilization management , chief medical officers, physicians and member/provider inquiries/appeals. ... JOB DESCRIPTION **Job Summary** The Medical Claim Review Nurse provides support for medical claim review activities....Further details to be discussed during the interview process. Remote position Work hours: Monday - Friday 8:00am -… more
- Centene Corporation (Tallahassee, FL)
- …28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive ... Analyzes BH member data to improve quality and appropriate utilization of services + Provides education to providers members...Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- Highmark Health (Tallahassee, FL)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... within the first 6 months of employment. **Preferred** + Certification in utilization management or a related field + Certification in Case Management … more
- 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...We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position… more
- Community Health Systems (Naples, FL)
- THIS IS NOT A REMOTE POSITION **Job Summary** The Care Manager - RN is responsible for coordinating and overseeing discharge planning, transitions of care, and case ... management activities to ensure optimal patient outcomes. This role...assess the appropriateness of admission, continued hospital stay, and utilization of diagnostic services. + Collaborates with interdisciplinary teams… more
- Molina Healthcare (Tampa, FL)
- …of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. ... that has a current active unrestricted license This a remote role and can sit anywhere within the United...3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review. + Minimum two… more
- Sharecare (Tallahassee, FL)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... the Family Health Advocate is an exciting and innovative remote role newly created to provide meaningful support to...+ Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex… more
- Sedgwick Government Solutions (Orlando, FL)
- …Lead ( Remote ) Strong Internal 2025-1453 Orlando, FL, USA Medical Case Management Full Time Description ** Remote Medical Case Manager Team Lead** Overview ... or Associate in Nursing (ASN) or Nursing Diploma + Unrestricted Current State Registered Nurse License + National certification in case management + A minimum of… more
- Community Health Systems (Naples, FL)
- …Dental, Vision) **Job Summary** The Care Manager - LPN supports effective utilization management and discharge planning by coordinating patient care activities ... **THIS IS NOT A REMOTE POSITION** **Benefits** ** Tuition Reimbursement ** 401K...escalating cases as needed to the Physician Advisor or Utilization Management (UM) committee. + Identifies avoidable… more
- Adecco US, Inc. (Tampa, FL)
- …hospital setting. **PREFERRED QUALIFICATIONS** : + Previous comprehensive care continuum management , utilization review or discharge planning experience. + HMO ... understanding of the cost consequences resulting from care delivery decisions through utilization of reports and systems such as Health Plan Benefits, utilization… more