• Clinical Review Nurse

    Actalent (Orlando, FL)
    …ensure the successful completion of cases. Essential Skills + Experience in utilization management, concurrent review, prior authorization, utilization ... + Active Compact RN License, Compact LPN is okay too + Utilization Management/Concurrent Review experience. + ICU/ER experience. + Strong communication skills. +… more
    Actalent (08/02/25)
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  • Care Review Clinician, PA (RN) Transplants

    Molina Healthcare (Tampa, FL)
    …holidays.** Preferred Experience Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge ... and eligibility for requested treatments and/or procedures. + Conducts prior authorization reviews to determine financial responsibility for Molina Healthcare… more
    Molina Healthcare (07/17/25)
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  • Clinical Review Nurse (RN) - Remote

    Actalent (Miami, FL)
    …to assist each other and complete cases. Qualifications: + 2+ years of utilization management, concurrent review, prior authorization, utilization review, ... case management, and discharge planning is must + ICU/ER experience Preferred + Active RN Compact License is Must  If you are Interested , Kindly give a call : ### Pay and Benefits The pay range for this position is $35.00 - $40.00/hr. Eligibility… more
    Actalent (08/01/25)
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  • (USA) Senior Manager I, Reliability

    Walmart (Brooksville, FL)
    …and flow rates to maximize productivity; analyzing equipment needs to insure maximum utilization of all assets, prior to capital budgeting; advising the home ... in annual meetings, travel, weekly calls, coordination of operational strategy, utilization of assets to support volume changes and forecasting, and establishment… more
    Walmart (07/22/25)
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  • Clinical Pharmacist - Managed Care

    DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
    …management, safety programs, and medical/pharmacy cost savings + Make recommendations on utilization management edits such as Prior Authorization, Step Therapy ... and outliers, the development of educational material, the evaluation of prescriber utilization data, and the deployment of cost reduction strategies. The Clinical… more
    DOCTORS HEALTHCARE PLANS, INC. (07/25/25)
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  • Prior Authorization Nurse

    Actalent (Sunrise, FL)
    …utilization and capture data effectively. Responsibilities + Review prior authorization requests for medical necessity and appropriateness, utilizing standardized ... Utilization Management Nurse!Job Description The Utilization ...between the Medical Director, physicians, and office staff, resolving prior authorization issues. + Communicate denial determinations to providers… more
    Actalent (07/26/25)
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  • Registered Nurse RN Care Manager Pediatric…

    AdventHealth (Orlando, FL)
    …+ Bachelors degree in Nursing + Health-related masters degree or MSN + Prior Care Management/ Utilization Management experience + Professional Certification + ... of the implementation of the transitions of care plans prior to the discharge of the patient. The RN...physicians and the interdisciplinary team on issues related to utilization of resources, medical necessity, CMS CoP for Discharge… more
    AdventHealth (07/31/25)
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  • Pharmacist (100% Remote, PBM, Entry-level)

    Actalent (Tallahassee, FL)
    …(No time off during training) Overview Join a remote team conducting utilization management reviews (eg, prior authorizations, coverage exceptions). Work ... independently within a collaborative pharmacy team. Performance is measured by monthly quality and productivity goals. Key Qualifications + PharmD or BS in Pharmacy + 2+ years in retail, managed care, or clinical pharmacy + Active US pharmacist license in good… more
    Actalent (07/30/25)
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  • Registered Nurse Care Manager

    AdventHealth (Winter Garden, FL)
    …+ Bachelors degree in Nursing + Health-related masters degree or MSN + Prior Care Management/ Utilization Management experience + Professional Certification This ... of the implementation of the transitions of care plans prior to the discharge of the patient. The RN...physicians and the interdisciplinary team on issues related to utilization of resources, medical necessity, CMS CoP for Discharge… more
    AdventHealth (07/10/25)
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  • Registered Nurse Care Manager

    AdventHealth (New Smyrna Beach, FL)
    …qualifications:** + BSN + Health-related Master's degree or MSN + Prior Care Management/ Utilization Management experience ACM/CCM Certification This facility ... of the implementation of the transitions of care plans prior to the discharge of the patient. The RN...physicians and the interdisciplinary team on issues related to utilization of resources, medical necessity, CMS CoP for Discharge… more
    AdventHealth (08/01/25)
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