- Elevance Health (Miami, FL)
- …members and providers. **How you will make an impact:** + Perform physician-level case review , following initial nurse review , of Medical Oncology regimens ... and supportive care. + Perform physician-level case review , following initial nurse review ,...maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care. + Participate… more
- HCA Healthcare (Tallahassee, FL)
- …position if current and compliant** + **Certification in Case Management, Nursing, or Utilization Review , preferred** + **Three years of nursing experience in ... throughput while supporting a balance of optimal care and appropriate resource utilization . The RN CM Care Coordinator will identify potential barriers to patient… more
- HCA Healthcare (Tallahassee, FL)
- …position if current and compliant** + **Certification in Case Management, Nursing, or Utilization Review , preferred** + **Three years of nursing experience in ... throughput while supporting a balance of optimal care and appropriate resource utilization . The RN CM Care Coordinator will identify potential barriers to patient… more
- Select Medical (Lake Worth, FL)
- …and professional growth of the department, including, but not limited to: Utilization Review (UR) and resource management, discharge planning, treatment plan ... of Case Management** **$10,000 Sign On Bonus** **_Clinical license as a registered nurse or respiratory therapist or master's in social work and minimum three (3)… more
- Select Medical (Gainesville, FL)
- …and professional growth of the department, including, but not limited to: Utilization Review (UR) and resource management, discharge planning, treatment plan ... On Bonus** **Full Time: Monday - Friday 8-5pm** **_Clinical license as a registered nurse or respiratory therapist or master's in social work and minimum three (3)… more
- Highmark Health (Tallahassee, FL)
- …of the claim rejection and the proper action to complete the retrospective claim review with the goal of proper and timely payment to provider and member ... Payment Integrity strategies on a pre-payment and retrospective claims review basis. Review process includes a ...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
- Elevance Health (Miami, FL)
- …or equivalent. Requires a minimum of 4 years of clinical experience and/or utilization review experience. Current active, valid and unrestricted LPN/LVN license ... Med Management Clinician Senior- Licensed Nurse **Location:** Miami, FL **Hybrid 1** : This...initiatives to improve the efficiency and effectiveness of the utilization reviews within the medical management processes. + Assesses… more
- HCA Healthcare (Ocala, FL)
- …required + 4 year Bachelor Degree preferred. + Certification in Case Management or Utilization Review preferred HCA Florida Ocala Hospital is a 323-bed facility. ... supporting a balance of optimal care and appropriate resource utilization . + Provides case management services for both inpatient...assigned **What qualifications you will need:** + (RN) Registered Nurse + Associate Degree + 2 years acute hospital… more
- BayCare Health System (Bradenton, FL)
- …bodies within the area of responsibility. + Ensure quality assurance program and utilization review is followed in accordance with Home Care protocol. + ... Participates with Case Manager on initial Plan of Care review with a focus on quality, utilization ...regulatory standards appropriate to position. **Requirements:** + RN (Registered Nurse ) License + Driver's License, State of Florida required… more
- BayCare Health System (Dunedin, FL)
- …regulatory bodies within the area of responsibility + Ensure quality assurance program and utilization review is followed in accordance with Home Care protocol + ... Participates with Case Manager on initial Plan of Care review with a focus on quality, utilization ...Health RN visit experience. **Required Credentials:** + RN (Registered Nurse ) License + Diploma, Associate's or Bachelor's Nursing +… more