- Centene Corporation (Tallahassee, FL)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... a fresh perspective on workplace flexibility. **Position Purpose:** Performs a clinical review and assesses care related to mental health and substance abuse.… more
- Centene Corporation (Tallahassee, FL)
- …assess ABA Treatment Plans required. Knowledge of ABA services and BH utilization review process required. Experience working with providers and healthcare ... behavioral analytics (ABA). Additional Details: * Department: Behavioral Health Utilization Management * Business Unit: Corporate / Florida *...teams to review care services related to Applied Behavior Analysis Services… more
- Monte Nido (Miami, FL)
- …lives while providing the opportunity for people to realize their healthy selves. ** Utilization Review Clinician** **Monte Nido** **Remote - EST or CST hours** ... strategies to provide comprehensive care within an intimate home setting. The Utilization Review **Clinician** is responsible for conducting daily administrative… more
- Actalent (Orlando, FL)
- …to validate the necessity and setting of care. Essential Skills + Proficiency in utilization management and utilization review + Experience with Interqual ... Job Title: Clinical Review Nurse Job Description As a Clinical Review Nurse, you will perform concurrent reviews to assess members' overall health, review … more
- Trinity Health (Fort Lauderdale, FL)
- …Care Plans to ensure authorization for hospital stay. Hybrid Position **_Position Purpose:_** ** Utilization Review (UR) Nurses play a vital role in healthcare by ... hospital clinical experience is required.** Recent experience in case management, utilization review , discharge planning, ongoing monitoring and evaluation of… more
- Actalent (Sunrise, FL)
- …UMN assists in complex cases, develops internal processes, and educates physicians on utilization review issues. The role involves managing continuity of care, ... and present reports on department activities as assigned. Essential Skills + Clinical review + Utilization review + Utilization management + InterQual +… more
- Community Health Systems (Naples, FL)
- …improvement programs + Addresses facility and departmental communication through daily review of all correspondence, including incoming email messages. + Performs ... other duties as assigned. + Complies with all policies and standards. **Qualifications** + Associate Degree Graduate from an Accredited School of Nursing, ASN required or + Bachelor's Degree BSN required + 2-4 years clinical practice experience required +… more
- AdventHealth (Tampa, FL)
- …reviews within 24 hours of admission; and when warranted by length of stay, utilization review plan, and/or best practice guidelines, on a continuing basis. ... diseases. **The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use...to the Physician Advisor or designated leader for additional review as determined by department standards. Additionally, the UM… more
- Actalent (Sunrise, FL)
- …+ Prepare and present reports on department activities as assigned. Essential Skills + Clinical review + Utilization review + Utilization management + ... unrestricted Florida RN or LPN License. + Minimum of one year of utilization review experience and discharge planning in an acute care setting. + Four years… more
- Molina Healthcare (FL)
- …and Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/ utilization review , and/or other utilization management ... clinical and non-clinical team activities to facilitate integrated, proactive utilization management, ensuring compliance with regulatory and accrediting standards.… more