- Humana (Tallahassee, FL)
- …a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and… 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)
- …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
- BayCare Health System (Tampa, FL)
- …foundation of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior responsibilities include:** + Functions ... Call:** No **Certifications and Licensures:** + Required RN (Registered Nurse ) + Preferred ACM (Case Management) + Preferred CCM...Nursing or Business **Experience:** + Required 2 years in Utilization Review or + Required 2 years… more
- BayCare Health System (Clearwater, FL)
- …foundation of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior responsibilities include:** + Functions ... Call:** No **Certifications and Licensures:** + Required RN (Registered Nurse ) + Preferred ACM (Case Management) + Preferred CCM...Nursing or Business **Experience:** + Required 2 years in Utilization Review or + Required 2 years… 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 ... 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
- AdventHealth (Orlando, 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. + ... environment. **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
- Elevance Health (FL)
- …prior authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification ... ** Utilization Management Representative I** **Location:** Virtual: This role...responsible for coordinating cases for precertification and prior authorization review . **How will you make an impact:** + Managing… more