- CVS Health (Tallahassee, FL)
- …Microsoft Office Applications (Outlook, Teams, Excel) **Preferred Qualifications** + Prior authorization utilization experience preferred + Outpatient Clinical ... opportunities to promote quality effectiveness of Healthcare Services and benefit utilization + Consults and lends expertise to other internal and external… more
- CVS Health (Tallahassee, FL)
- …+ 3+ years of Nursing experience. Preferred Qualifications + Prior authorization utilization management/review experience preferred Outpatient Clinical ... opportunities to promote quality effectiveness of Healthcare Services and benefit utilization . + Consults and lends expertise to other internal and external… more
- Humana (Tallahassee, FL)
- …make an impact** **Required Qualifications** + 1 or more years of experience with Utilization Review and/or Prior Authorization + 1 or more years of Healthcare ... experience + Working knowledge of Microsoft Word, Excel, and Outlook. + Live in CST or EST states + Monday-Friday 8am-5pm EST, and work 1 weekend a quarter. Schedule subject to change based on business needs. **Preferred Qualifications** + Bilingual… 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
- CVS Health (Tallahassee, FL)
- …5 years of relevant experience in Nursing. + At least 1 year of Utilization Management experience in concurrent review or prior authorization. + Strong ... that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant to join our remote team. **Key… more
- Molina Healthcare (Orlando, FL)
- …family include those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and ... comply with CMS guidelines. These staff may also be involved in providing utilization management/ prior authorization services as needed. * Supervises the unit's… 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
- Veterans Affairs, Veterans Health Administration (Winter Park, FL)
- …throughout the continuum of care. Responsibilities The Community Care (CC) Utilization Review Registered Nurse (RN) is responsible for collecting, interpreting, and ... reviewing and care coordination for the VAHCS. The CC Utilization Review RN performs a wide variety of clinical...subject to urinalysis to screen for illegal drug use prior to appointment. Applicants who refuse to be tested… more
- CenterWell (Tallahassee, FL)
- …member service or customer service telephone experience desired + Experience with Utilization Review and/or Prior Authorization, preferably within a managed care ... first** The UM Administration Coordinator 2 contributes to administration of utilization management. The UM Administration Coordinator 2 performs varied activities… 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
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