- Actalent (Sunrise, FL)
- Utilization Management Nurse !Job Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing service authorization requests to ... ensure appropriate service utilization . Working under the general supervision of the Director...Medical Directors and other Medical Management staff to direct utilization and capture data effectively. Responsibilities + Review prior… more
- Actalent (Sunrise, FL)
- Actalent is hiring a Utilization Management Nurse ! Job Description The Utilization Management Nurse (UMN) collaborates closely with the interdisciplinary ... team to perform reviews of service authorization requests, ensuring the utilization of appropriate services. The UMN assists in complex cases, develops internal… more
- AdventHealth (Tampa, FL)
- …cancer and other diseases. **The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use clinical expertise ... order or a status conflict is indicated, the UM nurse is responsible for escalation to the Physician Advisor...of admission; and when warranted by length of stay, utilization review plan, and/or best practice guidelines, on a… more
- CVS Health (Tallahassee, FL)
- …AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support ... clinical skills to coordinate, document and communicate all aspects of the utilization /benefit management program. + Utilizes clinical experience and skills in a… more
- CVS Health (Tallahassee, FL)
- …opportunities to promote quality effectiveness of Healthcare Services and benefit utilization + Consults and lends expertise to other internal and external ... constituents in the coordination and administration of the utilization /benefit management function. + Typical office working environment with productivity and… more
- CVS Health (Tallahassee, FL)
- …Medical Director referral as needed. + Assists management with training new nurse reviewers/business partners or vendors to include initial and ongoing mentoring, ... 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 experience. + Must… more
- CenterWell (Tallahassee, FL)
- …Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to ... procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare/Medicaid… more
- Humana (Tallahassee, FL)
- …a part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to support the ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and… more
- Community Health Systems (Naples, FL)
- **Job Summary** Under the direction of the UR Director/Manager the UR Nurse reviews all admissions for medical necessity, correct orders based on medical condition ... and verbal communication skills. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or Compact State Licensure Current RN license as… more
- Ascension Health (Pensacola, FL)
- **Details** + **Department: Utilization Management** + **Schedule: Full time days** + **Hospital: Ascension Sacred Heart Pensacola** + **Location: Pensacola, ... health care services regarding admissions, case management, discharge planning and utilization review. + Review admissions and service requests within assigned unit… more