- Actalent (Orlando, FL)
- Job Title: Clinical Review Nurse Job Description As a Clinical Review Nurse , you will perform concurrent reviews to assess members' overall health, ... and setting of care. Essential Skills + Proficiency in utilization management and utilization review ...Texas nursing license. Work Environment This is a fully remote position with working hours from 10 am to… more
- CVS Health (Tallahassee, FL)
- …(RN) - active license. + 3+ Years of clinical experience. + 1+ Year of Utilization Review Management and/or Medical Management experience. + Must have active and ... And we do it all with heart, each and every day. This position will be remote working from home anywhere in the US. **Schedule is Monday - Friday 8am-5pm est.** No… more
- CVS Health (Tallahassee, FL)
- …healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant to join our remote team. **Key Responsibilities** + Apply ... may vary based on business needs) **Location** : 100% Remote (US only) **Position Summary** American Health Holding, Inc....experience in Nursing. + At least 1 year of Utilization Management experience in concurrent review or… more
- CVS Health (Tallahassee, FL)
- …do it all with heart, each and every day. **Position Summary** Fully remote role in the USA. **Requires Monday-Frida** y: 11:30am-8:00pm EST shift; 8:30am-5:00pm ... AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support… more
- CVS Health (Tallahassee, FL)
- …of varied UM ( utilization management) experience within an inpatient, concurrent review or prior authorization. + Remote work experience. **Education** + ... with heart, each and every day. **Position Summary** **100% remote position from anywhere in the US** **Work hours:...utilization management) experience within an **outpatient** setting, concurrent review or prior authorization. + 5 years of a… more
- CVS Health (Tallahassee, FL)
- …care **Preferred Qualifications** + NICU experience highly preferred + Managed care/ utilization review experience + Ability to multitask, prioritize and ... and every day. **Position Summary** This is a fully remote role open to candidates with an active RN...the telephone, and typing on the computer. The UM Nurse Consultant utilizes clinical skills to coordinate, document and… more
- CenterWell (Tallahassee, FL)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to… more
- Centene Corporation (Tallahassee, FL)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... a fresh perspective on workplace flexibility. **Position Purpose:** Performs a clinical review and assesses care related to mental health and substance abuse.… more
- Centene Corporation (Tallahassee, FL)
- …assess ABA Treatment Plans required. Knowledge of ABA services and BH utilization review process required. Experience working with providers and healthcare ... benefits including a fresh perspective on workplace flexibility. NOTE: This is a fully remote role. Preference will be given to applicants who reside in Florida, who… more
- Actalent (Miami, FL)
- …complete cases. Qualifications: + 2+ years of utilization management, concurrent review , prior authorization, utilization review , case management, and ... Urgent Hiring for " Remote Clinical Review Nurses" Job Description: + Review approximately 20 cases a day for medical necessity. + Advocate for and protect… more
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