- Actalent (Orlando, FL)
- Job Title: Clinical Review Nurse Job Description As a Clinical Review Nurse , you will perform concurrent reviews to assess members' overall health, ... the necessity and setting of care. Essential Skills + Proficiency in utilization management and utilization review + Experience with Interqual and Medicare +… more
- Community Health Systems (Naples, FL)
- **Job Summary** Under the direction of the UR Director/Manager the UR Nurse reviews all admissions for medical necessity, correct orders based on medical condition ... improvement programs + Addresses facility and departmental communication through daily review of all correspondence, including incoming email messages. + Performs… 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, ... Actalent is hiring a Utilization Management Nurse ! Job Description The...on department activities as assigned. Essential Skills + Clinical review + Utilization review +… more
- CVS Health (Tallahassee, FL)
- …UM ( utilization management) experience within an **outpatient** setting, concurrent review or prior authorization. + 5 years of a variety clinical experience ... a high-volume clinical call center environment. + 1 year of varied UM ( utilization management) experience within an inpatient, concurrent review or prior… more
- AdventHealth (Tampa, FL)
- …leader for additional review as determined by department standards. The Utilization Management Nurse is accountable for a designated patient caseload and ... **le you'll contribute:** The role of the Emergency Department Utilization Management (UM) Registered Nurse (RN) is...the Emergency Department Utilization Management (UM) Registered Nurse (RN) is to use clinical expertise by analyzing… more
- AdventHealth (Tampa, FL)
- …leader for additional review as determined by department standards. The Utilization Management Nurse is accountable for a designated patient caseload and ... role you'll contribute:** The role of the Emergency Department Utilization Management (UM) Registered Nurse (RN) is...the Emergency Department Utilization Management (UM) Registered Nurse (RN) is to use clinical expertise by analyzing… 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 the Physician Advisor or designated leader for additional review as determined by department standards. Additionally, the UM… more
- CenterWell (Tallahassee, FL)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work… more
- CenterWell (Tallahassee, FL)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to… 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