• Registered Nurse (On Call)

    MTC (Graceville, FL)
    …medical team who are dedicated to improving people's lives. We are seeking an **On-Call Registered Nurse ( RN )** to join our team. **Primary duties:** + ... forms as appropriate. + Practice basic cost containment and utilization management for inmate care and facility operations. +...HIPAA rules. + Accurately and promptly chart medical care. Review medical files to determine all provided services are… more
    MTC (08/14/25)
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  • Registered Nurse (On call)

    MTC (Panama City, FL)
    …The Bay Correctional Facility located in Panama City, FL. is **now hiring a part-time Registered Nurse ( RN )** to join our team. **Primary duties:** + Attend ... forms as appropriate. + Practice basic cost containment and utilization management for inmate care and facility operations. +...HIPAA rules. + Accurately and promptly chart medical care. Review medical files to determine all provided services are… more
    MTC (08/08/25)
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  • Appeals Registered Nurse

    Evolent (Tallahassee, FL)
    …focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and procedures ... work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators...Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
    Evolent (08/08/25)
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  • Registered Nurse Hospitalist East

    AdventHealth (Orlando, FL)
    …UNDERHILL ROAD, Orlando, 32822 **The role you'll contribute:** The Hospitalist RN functions in a supportive role to the contracted Hospitalist Physicians/Providers. ... The Hospitalist RN partners with the contracted Hospitalist MD/Provider and the...Avoids delay by ensuring test results are available for review and decision making. + Connects with Hospitalist providers… more
    AdventHealth (08/16/25)
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  • Registered Nurse

    MTC (Quincy, FL)
    …of nursing skills all in one package!** Are you a dedicated and skilled RN looking for a meaningful opportunity to provide exceptional care? We're hiring passionate ... forms as appropriate. + Practice basic cost containment and utilization management for inmate care and facility operations. +...HIPAA rules. + Accurately and promptly chart medical care. Review medical files to determine all provided services are… more
    MTC (08/23/25)
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  • Registered Nurse Wound Care PRN…

    AdventHealth (Ocala, FL)
    …in the Wound care center. This includes, but is not limited to, utilization of skills in organization, planning, implementing, evaluating, and providing care through ... standards. **The value you'll bring to the team:** + Review lab results for needed provider action and follow...need to succeed:** Completion of Nursing Program Active Florida RN License Current BLS This facility is an equal… more
    AdventHealth (08/07/25)
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  • Utilization Management RN

    AdventHealth (Orlando, FL)
    …environment. **The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse ( RN ) is to use clinical expertise by analyzing ... of admission; and when warranted by length of stay, utilization review plan, and/or best practice guidelines,...and valid license to practice in Florida as a Registered Nurse (ADN or BSN) required. +… more
    AdventHealth (08/28/25)
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  • Utilization Management Nurse…

    CVS Health (Tallahassee, FL)
    …demonstrated ability to make thorough, independent decisions using clinical judgement. + A Registered Nurse that must hold an unrestricted license in their state ... UM ( utilization management) experience within an **outpatient** setting, concurrent review or prior authorization. + 5 years of a variety clinical experience… more
    CVS Health (08/15/25)
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  • Quality Review Nurse RN PRN…

    AdventHealth (Orlando, FL)
    **Quality Review Nurse RN PRN...Care experience + OASIS experience + PDGM experience + Registered Nurse State Licensure and/or Compact State ... FL, 32804 **The role you'll contribute:** Responsible for ensuring effective utilization and case management oversight activities as defined by interprofessional… more
    AdventHealth (08/27/25)
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  • Care Review Clinician, Prior Auth…

    Molina Healthcare (Tampa, FL)
    …for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of ... Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual… more
    Molina Healthcare (07/12/25)
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