- 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
- CenterWell (Tallahassee, FL)
- …Physical Therapy, DME, Cardiac or Orthopedic procedures + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/ ... 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… more
- CenterWell (Tallahassee, FL)
- …or Orthopedic procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/ ... 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… more
- Actalent (Miami, FL)
- …Essential Skills + Proficiency in utilization management and utilization review + Experience with Interqual and Medicare + Expertise in medical, acute ... Job Title: Clinical Review Nurse Job Description As a Clinical Review Nurse , you will perform concurrent reviews to assess members' overall health, … more
- Centene Corporation (Tallahassee, FL)
- …including treatment needs and appropriate level of care preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management ... discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in… more
- Actalent (Sunrise, FL)
- Utilization Management Nurse !Job Description The ...on department activities as assigned. Essential Skills + Clinical review + Utilization review + ... Milliman Commercial Guidelines + Medicaid + Medical management + Medicare + Managed care + Patient care + Medical...or LPN License. + Minimum of one year of utilization review experience and discharge planning in… more
- AdventHealth (Orlando, FL)
- …to nurses, physicians and the interdisciplinary team on issues related to utilization of resources, medical necessity, CMS CoP for Discharge Planning and care ... (as permitted by the patient) as well as a review of the current and past inpatient and outpatient...avoidable days, and facilitates progression of care. Collaborates with Utilization Management staff for collaboration on patient status changes… more
- Molina Healthcare (Tampa, FL)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases… more
- CVS Health (Tallahassee, FL)
- …advocates for members who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current case management and ... community + Utilizes weekly and daily reporting to identify utilization for the purpose of reducing Emergency Department ...must have an active and unrestricted Compact Licensed Practical Nurse (LPN) License in state of residence + 3+… more
- Molina Healthcare (FL)
- …the Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the ... and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource… more