- Monte Nido (Miami, FL)
- …while providing the opportunity for people to realize their healthy selves. ** Utilization Review Clinician** **Monte Nido** **Remote** **Monte Nido has been ... provide comprehensive care within an intimate home setting. We are seeking a Utilization Review Clinician to join our team based Remotely. **This is a Full-Time… more
- Ascension Health (Destin, FL)
- **Details** + **Department: Utilization Review ** + **Schedule: Part time, 3 days per week; 8 hours per day. 8 am- 4:30 pm** + **Hospital: Ascension Sacred Heart ... health care services regarding admissions, case management, discharge planning and utilization review . + Review admissions and service requests within… more
- 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 ... Analyzes BH member data to improve quality and appropriate utilization of services + Interacts with BH healthcare providers...teams to review care services related to Applied Behavior Analysis Services… more
- Humana (Tallahassee, FL)
- …Registered Nurse (RN) license in the state of Michigan. + Previous experience in utilization management and/or utilization review . + Minimum of two (2) ... of our caring community and help us put health first** The Manager, Utilization Management Nursing (LTSS Utilization Management Leader) utilizes clinical nursing… more
- AdventHealth (Daytona Beach, 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. + ... 32117 **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
- Humana (Tallahassee, FL)
- …Coordinator or discharge planner in an acute care setting + Previous experience in utilization management/ utilization review for a health plan or acute care ... part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
- Prime Therapeutics (Tallahassee, FL)
- …+ Escalates medical exception requests to nurse, pharmacist or physician on the utilization review clinical team when further review is necessary. ... our passion and drives every decision we make. **Job Posting Title** Initial Review Pharmacy Technician - Remote **Job Description** The Initial Review Pharmacy… more
- Molina Healthcare (Tampa, FL)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically… more
- Molina Healthcare (Tampa, FL)
- …SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years ... set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing clinical knowledge and experience,… more