- 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
- CVS Health (Tallahassee, FL)
- …status which has resulted in an inpatient admission. The Transition of Care (TOC) RN ensures the member experiences a seamless transition to their next care setting. ... overall wellness through integration. . Using clinical tools and information/data review , conducts comprehensive assessments of member's needs and recommends an… more
- HCA Healthcare (Fort Pierce, FL)
- …etc.) hospital nursing experience required + Certification in case management or utilization review preferred InterQual experience preferred HCA Florida Lawnwood ... personal growth, we encourage you to apply for our RN Case Mgr opening. We promptly review all applications. Highly qualified candidates will be contacted for… more
- HCA Healthcare (Margate, FL)
- …or 2 years of critical care experience + Certification in case management or utilization review preferred + InterQual experience preferred + This position may be ... opportunity compelling, we encourage you to apply for our RN case Mgr PRN opening. We promptly review... RN case Mgr PRN opening. We promptly review all applications. Highly qualified candidates will be directly… more
- HCA Healthcare (Tampa, FL)
- …care.** + **You will collaborate medical treatment with third party payers and utilization review department to qualify patients for current or continued care ... your career path, we encourage you to apply for our RN Psych Intake Specialist opening. We review all applications. Qualified candidates will be contacted by a… more
- HCA Healthcare (Aventura, FL)
- …etc.) hospital nursing experience required + Certification in case management or utilization review preferred + InterQual experience preferred HCA Florida ... colleagues in their positions. Join our Team as a(an) RN Case Mgr and access programs to assist with...RN Case Mgr opening. Our team will promptly review your application. Highly qualified candidates will be contacted… more
- HCA Healthcare (Miami, FL)
- …etc.) hospital nursing experience required + Certification in case management or utilization review preferred + InterQual experience preferred HCA Florida Mercy ... in your career path, we encourage you to apply for our Case Mgr RN opening. We review all applications. Qualified candidates will be contacted by a member of our… more
- 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
- 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
- HCA Healthcare (Brooksville, FL)
- …Healthcare Quality) OR CHCQM (Diploma in American Board of Quality Assurance and Utilization Review Physicians). _Individuals without CPHQ or_ CHCQM _will be ... our Director, you will provide direction to ensure the facilitation and utilization of diverse strategies and communication for quality and performance improvement… more