- Actalent (Sunrise, FL)
- …+ Prepare and present reports on department activities as assigned. Essential Skills + Clinical review + Utilization review + Utilization management + ... Actalent is hiring a Utilization Management Nurse ! Job Description The Utilization Management Nurse...cases, develops internal processes, and educates physicians on utilization review issues. The role involves managing continuity of care,… more
- Centene Corporation (Tallahassee, FL)
- …Reside in Florida!** **Centene is Hiring!** **We're looking for a Remote Concurrent Review Nurse to support our Medicaid team.** **Ideal Candidate:** + **Has ... the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified,… more
- Centene Corporation (Tallahassee, FL)
- …the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, ... and cost effectiveness of medical care. + Performs medical necessity and clinical reviews of authorization requests to determine medical appropriateness of care in… more
- University of Miami (Miami, FL)
- …review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . Clinical Business Operations Specialist Hybrid option ... meetings, office supplies, and promotional items. + Monitor and review clinical and clerical CRM WQ and...and licenses. + Provide administrative and clerical support to Nurse Practitioners, Fellows, and Instructors. + Collect and distribute… more
- University of Miami (Miami, FL)
- …full-time Clinical Business Operations Representative 2 to work in a hybrid manner. The Clinical Business Operations Representative 2 facilitates the prompt ... faculty or staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The department of… more
- Elevance Health (Tampa, FL)
- ** Clinical Fraud Investigator II - Registered Nurse and CPC - Calrelon Payment Integrity SIU** **Location:** This role requires associates to be in-office 1 - 2 ... to recover, eliminate and prevent unnecessary medical-expense spending. The ** Clinical Fraud Investigator II** is responsible for identifying issues and/or… more
- Actalent (Sunrise, FL)
- …+ Prepare and present reports on department activities as assigned. Essential Skills + Clinical review + Utilization review + Utilization management + ... Utilization Management Nurse !Job Description The Utilization Management Nurse ...to direct utilization and capture data effectively. Responsibilities + Review prior authorization requests for medical necessity and appropriateness,… more
- ChenMed (Largo, FL)
- …care compliance and policies and procedures. The Register Nurse (RN) Community Care Nurse will serve as a clinical lead for a Community Care team. They ... has completed their episode of care management the register nurse (RN) will review patient chart for...clinical field preferred + A valid, active Registered Nurse (RN) license in State of employment required. Compact… more
- CenterWell (Daytona Beach, FL)
- …interdisciplinary care integration team (CIT), the Care Navigator - Registered Nurse is responsible for proactively engaging patients and implementing targeted ... increased access to care. The Care Navigator - Registered Nurse will provide guidance and oversight of care coordination...efforts to other members of the team, and manage clinical escalations as indicated. This role requires an understanding… more
- ICW Group (Orlando, FL)
- …**PURPOSE OF THE JOB** The purpose of this job is to perform clinical assessment and evaluate needs for treatment in worker's compensation claims. The Telephonic ... Nurse Case Manager will negotiate and coordinate appropriate medical...the case management process. + Performs initial and ongoing clinical assessment via telephone calls to relevant parties that… more