- Humana (Tallahassee, FL)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...who will assist in preparation of cases prior to review by the Humana G&A Medicare Medical Directors. The… more
- CenterWell (Tallahassee, FL)
- …+ Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Orthopedic procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare… more
- BayCare Health System (Tampa, 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 ... of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior/RN responsibilities include:** + Functions… more
- Humana (Tallahassee, FL)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...in an acute care setting + Previous experience in utilization management / utilization review … more
- CVS Health (FL)
- …work Monday through Friday 8:30-5pm EST. No weekends or holidays. + 1+ years of utilization review / utilization management required. + 3+ years of ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable… more
- AdventHealth (Tampa, FL)
- …in emergency department setting. + Utilize critical thinking and expertise in utilization review regarding medical necessity, patient status, level of care, ... Issuing Body, Certified Case Manager (CCM) - EV Accredited Issuing Body, Registered Nurse (RN) - EV Accredited Issuing Body **Pay Range:** $32.76 - $57.47 _This… more
- Molina Healthcare (Miami, FL)
- …ensure appropriate reimbursement to providers. + Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) ... modification of payment decisions. + Serves as a clinical resource for utilization management , CMOs, physicians and member/provider inquiries/appeals. + Provides… more
- Actalent (Orlando, FL)
- Remote Clinical Review Nurse - Prior Authorization Location: Must be located in Central or Eastern time zones Employment Type: Full‑Time About the Role We are ... seeking an experienced Registered Nurse to join our team within a leading Managed...organizational standards. + Maintain up‑to‑date knowledge of clinical guidelines, utilization management policies, and industry best practices.… more
- Cleveland Clinic (Vero Beach, FL)
- …world. As a Concurrent Denial Nurse , you will support the Utilization Management Department by reviewing concurrent and retrospective clinical inpatient ... Nurse who is a subject matter expert in utilization management , has experience with MCG criteria,...to the department in general and the hospital. + Review and analyze concurrent and retrospective clinical denials and… more
- Humana (Tallahassee, FL)
- …for review depending on case findings. Educates providers on utilization and medical management processes. Enters and maintains pertinent clinical ... community and help us put health first** The Pre-Authorization Nurse 2 reviews prior authorization requests for appropriate care...to make an impact** **Required Qualifications** + 2+ years Utilization Management experience + Active RN license… more