- CenterWell (Tallahassee, FL)
- …our caring community and help us put health first** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent critical ... **Required Qualifications** + Must be a licensed Registered Compact Nurse license (RN) with no disciplinary action and ability...Lung or Critical Care Nursing experience required + Prior clinical experience preferably in an acute care, skilled or… more
- Centers Plan for Healthy Living (Margate, FL)
- …For Healthy Living is currently accepting applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works ... in their home to improve their quality of life. Utilization Management Clinical Reviewer will assess and process all authorization requests to determine medical… more
- Molina Healthcare (Miami, FL)
- …**Job Summary** The RN Care Review Clinician provides support for clinical member services review assessment processes. Responsible for verifying that services ... are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through… more
- CVS Health (FL)
- … Nurse Consultant** Fully Remote- WFH- 8A-5P in EST or CST **Position Summary** UM Nurse Consultant Utilizes clinical experience and skills in a ... options to facilitate appropriate healthcare services/benefits for members. Gathers clinical information and applies the appropriate clinical criteria/guideline,… more
- Evolent (Tallahassee, FL)
- …coordinating with UM staff to ensure timely and accurate communication of clinical decisions. + Responsible for completion of UM projects and participation ... the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Practitioner/Physician Assistant (ARNP/NP/PA) Vascular Surgey is responsible for support and… more
- Evolent (Tallahassee, FL)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. ... policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member...medical management activities in a managed care environment + UM /UR experience + Clinical experience in Oncology,… more
- 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 a leading Managed...This role is fully remote and focuses on reviewing clinical documentation to determine medical necessity, appropriateness of care,… more
- University of Miami (Miami, FL)
- … Educator - Medical Simulation and Education Lab to work in Miami, FL. The Nurse Educator provides clinical education to nursing and patient care staff and ... community clinical partners, to ensure high quality clinical outcomes. The Simulation Nurse Educator is...per year. Training programs include curricula developed by the UM Gordon Center, and other organizations, such as the… more
- Cleveland Clinic (Vero Beach, FL)
- …most respected healthcare organizations in the world. As a Concurrent Denial Nurse , you will support the Utilization Management Department by reviewing concurrent ... and retrospective clinical inpatient denials to ensure medical necessity criteria is...criteria is met. We are looking for a Registered Nurse who is a subject matter expert in utilization… more
- University of Miami (Miami, FL)
- …Plans discharge and teaching nee ds as applicable. 4. Promotes development of clinical practice based on research and evidence. 5. Assists leadership team with ... maintenance of initial and ongoing unit - based clinical competencies Implementation 25% 1. Ensures that each clinic...any abnormal results (non - critical values) to the nurse who in turn will contact the physician accordingly… more