• Supervisor, Care Review ( RN…

    Molina Healthcare (Tampa, FL)
    …and Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/ utilization review, and/or other utilization management ... clinical and non-clinical team activities to facilitate integrated, proactive utilization management , ensuring compliance with regulatory and accrediting… more
    Molina Healthcare (08/20/25)
    - Related Jobs

  • Utilization Management Nurse…

    CVS Health (Tallahassee, FL)
    …active current and unrestricted RN licensure in state of residence. + Utilization Management is a 24/7 operation and work schedules will include weekends, ... **Required Qualifications** + 2+ years of experience as a Registered Nurse in adult acute care/critical care...or specialty area. + Managed Care experience preferred, especially Utilization Management . + Preference for those residing… more
    CVS Health (09/04/25)
    - Related Jobs

  • SNF Utilization Management RN…

    Humana (Tallahassee, FL)
    **Become a part of our caring community and help us put health first** The Utilization Management Registered Nurse 2 utilizes clinical nursing skills to ... determination of the appropriate courses of action. The SNF Utilization Management Registered Nurse...skills to make an impact** **Required Qualifications** + **Licensed Registered Nurse ( RN )** in the… more
    Humana (08/09/25)
    - Related Jobs

  • RN Utilization Management

    Humana (Tallahassee, FL)
    **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 +...skills to make an impact** **Required Qualifications** + Active Registered Nurse ( RN ) license in… more
    Humana (09/10/25)
    - Related Jobs

  • Utilization Review Clinician

    Monte Nido (Miami, FL)
    …reviews. + Communicate emerging trends with insurance companies to Director of Utilization Management . + Maintain database of insurance company clinical care ... providing the opportunity for people to realize their healthy selves. ** Utilization Review Clinician** **Monte Nido** **Remote** **Monte Nido has been delivering… more
    Monte Nido (09/06/25)
    - Related Jobs

  • 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 ... in applied behavioral analytics (ABA). Additional Details: * Department: Behavioral Health Utilization Management * Business Unit: Corporate / Florida *… more
    Centene Corporation (08/23/25)
    - Related Jobs

  • Utilization Review Clinician - Behavioral…

    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 ... be located in eastern or central time zone with experience in utilization management .** **Education/Experience:** Requires Graduate of an Accredited School… more
    Centene Corporation (07/31/25)
    - Related Jobs

  • Registered Nurse RN Care…

    AdventHealth (Orlando, FL)
    …documents avoidable days, and facilitates progression of care. Collaborates with Utilization Management staff for collaboration on patient status changes ... valid State of Florida or multistate license as a Registered Nurse + 2 years of medical/...+ Health-related masters degree or MSN + Prior Care Management / Utilization Management experience +… more
    AdventHealth (09/08/25)
    - Related Jobs

  • RN Registered Nurse Care…

    AdventHealth (Winter Park, FL)
    …documents avoidable days, and facilitates progression of care. Collaborates with Utilization Management staff for collaboration on patient status changes ... valid State of Florida or multistate license as a Registered Nurse + 2 years of medical/...+ Health-related masters degree or MSN + Prior Care Management / Utilization Management experience +… more
    AdventHealth (09/07/25)
    - Related Jobs

  • Medical Management Coordinator, RN

    DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
    …and goals. + Clearly and succinctly documents necessary and/or required information in Utilization Management system. + Monitors and complies with all state, ... subject matter expertise, as well as knowledge of the interconnection between Utilization Management , claims, and regulatory requirements to respond to complex… more
    DOCTORS HEALTHCARE PLANS, INC. (08/26/25)
    - Related Jobs