- BayCare Health System (Clearwater, FL)
- …2 years in Utilization Review or + Required 2 years in Case Management or + Required 3 years Registered Nurse + Preferred experience in Critical Care or ... foundation of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior responsibilities include:** + Functions… more
- Centene Corporation (Tallahassee, FL)
- …be located in eastern or central time zone with experience in utilization management .** **Education/Experience:** Requires Graduate of an Accredited School ... and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and… more
- Centene Corporation (Tallahassee, FL)
- …in applied behavioral analytics (ABA). Additional Details: * Department: Behavioral Health Utilization Management * Business Unit: Corporate / Florida * ... assess ABA Treatment Plans required. Knowledge of ABA services and BH utilization review process required. Experience working with providers and healthcare… more
- Elevance Health (FL)
- …precertification, prior authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer . + Responsible for the ... ** Utilization Management Representative I** **Location:** Virtual:...responsible for coordinating cases for precertification and prior authorization review . **How will you make an impact:** + Managing… more
- Centene Corporation (Tallahassee, FL)
- …a fresh perspective on workplace flexibility. **Centene is Hiring - Remote Clinical Review Nurse (Prior Authorization)!** **Ready to take your nursing career ... preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + LPN -… more
- Molina Healthcare (Tampa, FL)
- …Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... Experience using PEGA **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). MULTI STATE / COMPACT… more
- Centene Corporation (Tallahassee, FL)
- …preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + LPN - ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- ChenMed (Pembroke Pines, FL)
- …support patient self- management + Facilitate patient/family conferences to review treatment goals, optimize resource utilization , provide family education ... we need great people to join our team. The Nurse Case Manager I position is responsible for achieving...with patient and family. + Facilitate patient/family conferences to review treatment goals, optimize resource utilization , provide… more
- Sharecare (Tallahassee, FL)
- …appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants ... learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting...and to take the pre and post tests to review competency during orientation. Yearly competency tests are required… more
- Elevance Health (Miami, FL)
- …are 7am - 6pm EST and will include weekends. The **Medical Management Nurse ** will be responsible for review of the most complex or challenging cases ... **Medical Management Nurse ** **Location:** Virtual: This role...experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or… more