- CVS Health (Tallahassee, FL)
- …procedures/services or initiate a Medical Director referral as needed. + Assists management with training new nurse reviewers/business partners or vendors to ... meet quality and metric expectations. **Required Qualifications** + Registered Nurse (RN) - active license. + 3+ Years of...3+ Years of clinical experience. + 1+ Year of Utilization Review Management and/or Medical Management… more
- Centene Corporation (Tallahassee, FL)
- …will be located in eastern or central time zone with experience in utilization management .** **Education/Experience:** Requires Graduate of an Accredited School ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- Actalent (Orlando, FL)
- …to validate the necessity and setting of care. Essential Skills + Proficiency in utilization management and utilization review + Experience with Interqual ... Job Title: Clinical Review Nurse Job Description As a Clinical Review ...ER, Med-Surge, PACU, etc. + Strong multitasking and time management abilities. + Quick learner with a go-with-the-flow attitude.… more
- HCA Healthcare (Gainesville, FL)
- … nursing or behavioral health experience required + 1-3 years relevant case management / utilization review experience preferred + Must hold and maintain ... integrity. We care like family! Jump-start your career as a Behavioral Health Utilization Review RN MSW today with Parallon. **Benefits** Parallon offers a total… more
- Actalent (Sunrise, FL)
- Utilization Management Nurse !Job Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing service authorization ... activities as assigned. Essential Skills + Clinical review + Utilization review + Utilization management + Interqual + Milliman Commercial Guidelines… more
- Select Medical (Gainesville, FL)
- …focus on resource management . + Demonstrating compliance with facility-wide Utilization Management policies and procedures. + Coordinating UR compliance with ... **$10,000 Sign On Bonus** **_Clinical license as a registered nurse or respiratory therapist or master's in social work...growth of the department, including, but not limited to: Utilization Review (UR) and resource management , discharge… more
- Mayo Clinic (Jacksonville, FL)
- …patient plan of care throughout the continuum of care by ensuring appropriate utilization management , care coordination, resource utilization , and clinical ... RN Case Manager provides leadership through education on case management / utilization management concepts, committee work,...baccalaureate nursing program 3 years of acute nursing preferred; 1 year of Case Management … more
- Evolent (Tallahassee, FL)
- …sources to establish and maintain the definitive source of truth for specialty Utilization Management (UM) agreements. This important work is achieved through ... Minimum 3 years of professional experience in value-based healthcare analytics or utilization management within a payer, provider, clinical vendor, managed care,… more
- Molina Healthcare (FL)
- … and effective resource management . + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure ... IT and data analysts to produce tools to report, monitor and improve Utilization Management . + Actively participates in regulatory, professional and community… more
- Elevance Health (Tampa, FL)
- …in multiple states. **Preferred Skills, Capabilities and Experience:** + Experience in Utilization Management and/or Long Term Care Services Strongly Preferred. ... for people enrolled in Medicaid and/or Medicare programs in Florida. **Medical Management Clinician Associate** **Location:** The candidate must reside in the state… more