- Humana (Tallahassee, FL)
- …**3+ years of Skilled Nursing Facility experience and or Previous experience in utilization management** + Prior clinical experience preferably in an acute care, ... part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to support the… more
- Molina Healthcare (Tampa, FL)
- …standing. **Preferred Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and ... and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina Healthcare… more
- Evolent (Tallahassee, FL)
- …and stakeholders. + Familiarity with healthcare claims, reimbursement methodologies, and cost/ utilization KPIs, including prior authorization data and key ... : Analyze healthcare claims and authorization data to identify cost drivers, utilization trends, and population health opportunities using SAS, SQL, Excel, and Power… 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 processes,… 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 ... hours a day working with providers to secure additional information for prior authorization review. This candidate will utilize clinical skills to coordinate,… more
- Evolent (Tallahassee, FL)
- …with health care software development methodologies and lifecycles + Experience with utilization management and/or prior authorization processes is preferred + ... and implement intuitive, efficient, and engaging user interfaces for our Utilization Management health care workflow applications. User research and design system… more
- Centene Corporation (Tallahassee, FL)
- …applied behavioral analytics (ABA). Additional Details: * Department: Behavioral Health Utilization Management * Business Unit: Corporate / Florida * Schedule: ... (BH) and/or autism spectrum disorder needs and clinical standards + Performs prior authorization reviews related to BH to determine medical appropriateness in… more
- Centene Corporation (Tallahassee, FL)
- …to ensure level of care and services are medically appropriate + Performs prior authorization reviews related to mental health and substance abuse to determine ... discharge planning + Analyzes BH member data to improve quality and appropriate utilization of services + Provides education to providers members and their families… more
- Monte Nido (Miami, FL)
- …while providing the opportunity for people to realize their healthy selves. ** Utilization Review Clinician** **Monte Nido** **Remote - EST or CST hours** **Monte ... to provide comprehensive care within an intimate home setting. The Utilization Review **Clinician** is responsible for conducting daily administrative and… more
- CVS Health (Tallahassee, FL)
- …day. **Position Summary** **Fully remote with requirement to reside in Florida.** + Utilization Management is a 24/7 operation and the work schedule may include ... in Florida + 3+ years of clinical experience + Utilization Management is a 24/7 operation and work schedule...(Teams, Outlook, Word, Excel, etc.) **Preferred Qualifications** + Previous prior authorization experience + Prefer RN FL Compact license… more