• Clinical Review Nurse (Remote)

    Actalent (Orlando, FL)
    Remote Clinical Review Nurse - Prior Authorization Location: Must be located in Central or Eastern time zones Employment Type: Full‑Time About the Role We are ... seeking an experienced Registered Nurse to join our team within...to gather additional information when needed. + Document all review decisions clearly, accurately, and in compliance with regulatory… more
    Actalent (01/11/26)
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  • Concurrent Denial Nurse BU

    Cleveland Clinic (Vero Beach, FL)
    …Nursing or related field + Current valid license in the State of Florida as a Registered Nurse ( RN ) + Basic Life Support (BLS) certification through the ... healthcare organizations in the world. As a Concurrent Denial Nurse , you will support the Utilization Management...necessity criteria is met. We are looking for a Registered Nurse who is a subject matter… more
    Cleveland Clinic (01/15/26)
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  • Manager Emergency Services

    HCA Healthcare (Tallahassee, FL)
    …Life Supt must be obtained within 30 days of employment start date + (APRN) Advanced Practice Registered Nurse , or ( RN ) Registered Nurse + Associate ... and established productivity guidelines. + Manages operating expenses, including the utilization of supplies and equipment. + Identifies cost reduction opportunities… more
    HCA Healthcare (11/10/25)
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  • Director Case Management

    HCA Healthcare (Atlantis, FL)
    …degree in Nursing, Health Administration, or Business Administration, preferred + Either Registered Nurse ( RN ) licensure, Licensed Clinical Social Worker ... actively engaging interdisciplinary teams and external stakeholders. The Director is a registered nurse with responsibility for all operational aspects of the… more
    HCA Healthcare (12/14/25)
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  • Manager Case Management

    HCA Healthcare (Tallahassee, FL)
    …options and costs to patient and patient families. **What qualifications you will need:** + Registered Nurse , or Advance Practice Registered Nurse (APRN) ... planning. + Performs admission certification screening for patients in accordance with Utilization Plan using ISD criteria, and performs concurrent stay reviews at… more
    HCA Healthcare (11/10/25)
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  • Clinical Rehab Specialist PRN

    HCA Healthcare (Largo, FL)
    …verbal instructions, PC skills **What qualifications you will need:** + Bachelors Degree + ( RN ) Registered Nurse , or (OT) Occupational Therapist, or (LPT) ... meeting commitments to referral sources. Develops a call-plan to prioritize utilization of time. + Completes face-to-face, in-service educational contacts with… more
    HCA Healthcare (12/04/25)
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  • Clinical Reviewer, Nurse (Medical Oncology)

    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
    Evolent (12/10/25)
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  • Payment Integrity Clinician

    Highmark Health (Tallahassee, FL)
    …years of experience in Managed Care **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse **Preferred** + Certified Medical Coder or related **SKILLS** ... and the proper action to complete the retrospective claim review with the goal of proper and timely payment...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
    Highmark Health (11/14/25)
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  • Manager, Nursing (H)

    University of Miami (Miami, FL)
    …or responsibilities as necessary. CORE QUALIFICATIONS + Bachelor's degree in relevant field + Registered Nurse Licensure ( RN ), BLS, and ACLS Provider Card. + ... to apply for a faculty or staff position, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The University of… more
    University of Miami (12/20/25)
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  • SQPE Specialist II

    Cleveland Clinic (Vero Beach, FL)
    …for the ideal future caregiver include: + Master's Degree + Licensure as a Registered Nurse ( RN ) + Clinical experience (will offset three years ... compliance with all standards and favorable performance on safety, quality, utilization and experience metrics. + Participate in engraining the safety, quality… more
    Cleveland Clinic (01/07/26)
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