- Cognizant (Tallahassee, FL)
- …Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work related to clinical ... as well as timely filing deadlines and processes. + Review clinical denials including but not limited to referral,...Nurse (RN) + 2-3 years combined clinical and/or utilization management experience with managed health care plan +… 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 ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...Weekly Hours: 40 + Travel: While this is a remote position, occasional travel to Humana's offices for training… more
- Molina Healthcare (Jacksonville, FL)
- …candidate with a RN licensure, Diagnosis-Related Group (DRG) experience, 2 years of Utilization Review and/or Medical Claims Review experience. Knowledge in ... JOB DESCRIPTION **Job Summary** The RN Clinical Appeals Nurse provides support for internal appeals clinical processes...the specific programs supported by the plan such as utilization review , medical claims review ,… more
- Battelle Memorial Institute (Eglin AFB, FL)
- …within legal and professional parameters + Knowledge and skill in using pre-established utilization review criteria to recognize and report actual or potential ... (HRA) business line is seeking a highly motivated, full-time ** Nurse Case Manager** to join our team in support...model allows you to work 60% in-office and 40% remote , with Monday and Tuesday as common in-office days,… more
- Evolent (Tallahassee, FL)
- …the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
- Molina Healthcare (Orlando, FL)
- For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity of ... on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. JOB DESCRIPTION Job SummaryProvides support for clinical member… more
- Oracle (Tallahassee, FL)
- …(ECD) alignments, Critical Care workflow implementation, Multi-Disciplinary Rounding, and various nurse chart review and documentation optimizations. The ideal ... a prominent academic medical center in the Midwest. This remote role will act as the primary subject matter...offer ongoing consultation to support user proficiency and system utilization . Monitor project outcomes, track key metrics, and report… more
- Battelle Memorial Institute (Tampa, FL)
- …+ Under the supervision of a licensed psychiatrist, social worker, psychiatric nurse or psychologist, responsible for providing a wide range of behavioral health ... program policy + Coordinate attendance and agenda at Case Review Committee with military and civilian agencies + Coordinate...model allows you to work 60% in-office and 40% remote , with Monday and Tuesday as common in-office days,… more
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