- 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
- BayCare Health System (Tampa, FL)
- …Requirement:** Every Third Weekend + **On Call:** No **Certifications and Licensures:** + Required RN ( Registered Nurse ) + Preferred ACM (Case Management) + ... foundation of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior responsibilities include:** + Functions… more
- BayCare Health System (Clearwater, FL)
- …then eligible for remote) + **On Call:** No **Certifications and Licensures:** + Required RN ( Registered Nurse ) + Preferred ACM (Case Management) + Preferred ... foundation of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior responsibilities include:** + Functions… more
- Centene Corporation (Tallahassee, FL)
- …Family Therapist (LMFT) required or + Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State ... abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with...Care only: LMSW, LCSW, LMHC, LPC, LMFT, LMHP or RN required Pay Range: $26.50 - $47.59 per hour… more
- Centene Corporation (Tallahassee, FL)
- …Family Therapist (LMFT) required or + Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State ... assess ABA Treatment Plans required. Knowledge of ABA services and BH utilization review process required. Experience working with providers and healthcare… more
- CenterWell (Tallahassee, FL)
- …and the healthcare industry as a whole. Conviva Care Solutions is seeking a RN who will collaborate with other health care givers in reviewing actual and proposed ... medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part...skills to make an impact** **Role Essentials** + Active RN license + Possession of or ability to obtain… 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… more
- Molina Healthcare (Miami, 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
- HCA Healthcare (Jacksonville, FL)
- **Description** **Introduction** Do you have the PRN career opportunities as a ** Registered Nurse ( RN ) Case Manager** you want with your current employer? We ... expertise! **Job Summary and Qualifications** We are seeking a Registered Nurse ( RN ) Case Manager...this PRN role. + Certification in Case Management or Utilization Review is preferred. + InterQual experience… more
- HCA Healthcare (Orange Park, FL)
- **Description** **Introduction** Do you have the PRN career opportunities as a ** Registered Nurse ( RN ) Case Manager** you want with your current employer? We ... expertise! **Job Summary and Qualifications** We are seeking a Registered Nurse ( RN ) Case Manager...this PRN role.** + Certification in Case Management or Utilization Review is preferred. + InterQual experience… more
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