- CVS Health (Tallahassee, FL)
- …You can have life-changing impact on our members, who are enrolled in Care Management and present with a wide range of complex health and social challenges. With ... exciting opportunity as we grow and expand our Care Management Programs to change lives in new markets across...who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current… more
- AdventHealth (Orlando, FL)
- …documents avoidable days, and facilitates progression of care. Collaborates with Utilization Management staff for collaboration on patient status changes ... (as permitted by the patient) as well as a review of the current and past inpatient and outpatient...+ Health-related masters degree or MSN + Prior Care Management / Utilization Management experience +… more
- ChenMed (Plantation, 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
- AdventHealth (Winter Garden, FL)
- …documents avoidable days, and facilitates progression of care. Collaborates with Utilization Management staff for collaboration on patient status changes ... (as permitted by the patient) as well as a review of the current and past inpatient and outpatient...+ Health-related masters degree or MSN + Prior Care Management / Utilization Management experience +… more
- Elevance Health (Tampa, 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
- AdventHealth (Winter Park, FL)
- …experience *Experience in Case Management , Managed Care, Discharge Planning and Utilization Management *Case Management training *Specific knowledge and ... Scope and Standard for Nursing Practice, and the AONE Nurse Executive Competencies. *Liaises between Care Management ,...Avoids delay by ensuring test results are available for review and decision making. *Connects with hospital providers each… more
- Evolent (Tallahassee, FL)
- …quality and cost effective care delivery. **What You'll Be Doing:** + Performs utilization review of outpatient procedures and ancillary services. + Fulfills on ... for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are… more
- MyFlorida (Bradenton, FL)
- SENIOR COMMUNITY HEALTH NURSE - 64080249 Date: Aug 8, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... No: 858432 Agency: Department of Health Working Title: SENIOR COMMUNITY HEALTH NURSE - 64080249 Pay Plan: Career Service Position Number: 64080249 Salary: $64,480… more
- Prime Therapeutics (Tallahassee, FL)
- …of post-degree clinical experience. + Experience in managed care, specialty drugs, care management and utilization review . + Meets Credentialing criteria. + ... drives every decision we make. **Job Posting Title** Infusion Referral Nurse - REMOTE **Job Description** Under supervision, is responsible for performing referral… more
- HCA Healthcare (Miami, FL)
- … + Experience or 2 years of critical care experience + Certification in case management or utilization review preferred + InterQual experience preferred + ... our Registered Nurse RN Case Manager PRN opening. We promptly review all applications. Highly qualified candidates will be contacted for interviews. **Unlock the… more