• Utilization Review Clinician…

    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 ... and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and… more
    Centene Corporation (07/31/25)
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  • Utilization Review Clinician - ABA

    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
    Centene Corporation (08/02/25)
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  • Observation Utilization Review

    Trinity Health (Fort Lauderdale, FL)
    …Care Plans to ensure authorization for hospital stay. Hybrid Position **_Position Purpose:_** ** Utilization Review (UR) Nurses play a vital role in healthcare by ... hospital clinical experience is required.** Recent experience in case management, utilization review , discharge planning, ongoing monitoring and evaluation of… more
    Trinity Health (08/02/25)
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  • Utilization Review

    Community Health Systems (Naples, FL)
    …meet deadlines. + Effective written and verbal communication skills. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or Compact ... **Job Summary** Under the direction of the UR Director/Manager the UR Nurse reviews all admissions for medical necessity, correct orders based on medical condition… more
    Community Health Systems (07/12/25)
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  • Registered Nurse Utilization

    AdventHealth (Tampa, FL)
    …diseases. **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,...Nursing Required 3 years of relevant work experience required. Registered Nurse ( RN ) License Required.… more
    AdventHealth (08/08/25)
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  • Utilization Management Nurse

    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
    Actalent (07/29/25)
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  • Hybrid Clinical Review Nurse

    Actalent (Sunrise, FL)
    Utilization Management Nurse !Job Description The ...on department activities as assigned. Essential Skills + Clinical review + Utilization review + ... record Additional Skills & Qualifications + Current unrestricted Florida RN or LPN License. + Minimum of one year...or LPN License. + Minimum of one year of utilization review experience and discharge planning in… more
    Actalent (08/09/25)
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  • Supervisor, Care Review ( RN )

    Molina Healthcare (FL)
    …and Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/ utilization review , and/or other utilization management ... leadership skills. **Required License, Certification, Association** + Active, unrestricted State Registered Nursing ( RN ) in good standing. + MULTI STATE… more
    Molina Healthcare (07/27/25)
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  • Care Review Clinician, PA ( RN )

    Molina Healthcare (St. Petersburg, 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 (08/08/25)
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  • Medical Claim Review Nurse

    Molina Healthcare (St. Petersburg, FL)
    …SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years ... state/federal regulations **REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:** Active, unrestricted State Registered Nursing ( RN ) license in good standing.… more
    Molina Healthcare (08/08/25)
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