- Molina Healthcare (Jacksonville, FL)
- …Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). **MULTI STATE / COMPACT… more
- ChenMed (Bradenton, FL)
- …explain nurse practitioner role. + Facilitates patient/family conferences to review treatment goals, optimize resource utilization , provide family education ... we need great people to join our team. The Nurse Practitioner (NP) acts as part of the clinical...management programs, clinical meetings and other meetings. The Nurse Practitioner will adhere to strict departmental goals/objectives, standards… more
- Elevance Health (Tampa, FL)
- …EST and will include every weekend (Saturday and Sunday). The **Medical Management Nurse ** will be responsible for review of the most complex or challenging ... **Medical Management Nurse ** **Location:** This role enables...experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or… more
- MyFlorida (St. Augustine, FL)
- ADVANCED PRACTICE REGISTERED NURSE - 64084590 Date: Nov 18, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify ... Agency: Department of Health Working Title: ADVANCED PRACTICE REGISTERED NURSE - 64084590 Pay Plan: Career Service Position Number:...written protocols. This includes but not limited to the review of prior medical records, reports and lab results… more
- Highmark Health (Tallahassee, FL)
- …triaging members to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, ... Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or… more
- AdventHealth (Orange City, FL)
- …of Nursing. + Health-related master's degree or MSN. + Prior Care Management / Utilization Management experience. + ACM/CCM Certification. This facility ... Manager is under the general supervision of the Care Management Supervisor or Manager or Director of Nursing and...physicians and the interdisciplinary team on issues related to utilization of resources, medical necessity, CMS CoP for Discharge… more
- AdventHealth (Tampa, FL)
- …in conducting performance appraisals for personnel on assigned shift. The Registered Nurse provides self-directed, effective nursing care to groups of patients and ... with customer service behaviors and reinforces hospital goals for service management . PEOPLE: * Adheres to organizational standards for dress and professional… more
- 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...Looking for a RN with experience with appeals, claims review , and medical coding. JOB DESCRIPTION Job SummaryProvides support… more
- HCA Healthcare (Margate, FL)
- … + Experience or 2 years of critical care experience + Certification in case management or utilization review preferred + InterQual experience preferred + ... collaborates with the Rehab Program Director and Facility Case Management Director regarding departmental functions. The CM coordinates efforts...growth, we encourage you to apply for our Registered Nurse RN case Mgr opening. We promptly review… more
- HCA Healthcare (Tallahassee, FL)
- …and personal growth, we encourage you to apply for our Operating Room Nurse PRN-Surgery Center opening. We review all applications. Qualified candidates will ... have the PRN career opportunities as an Operating Room Nurse PRN-Surgery Center you want with your current employer?...the instrument and equipment set-up for your OR, including utilization of preference cards and ability to anticipate your… more