• Remote Utilization Review…

    Actalent (Sunrise, FL)
    Actalent is Hiring a Remote DietitianPosition Purpose: The Registered Dietitian will provide clinical education and support for Ambetter members enrolled in Disease ... + Backed by a non-clinical support team and market-level partnerships. Work Environment Remote Work Pay and Benefits The pay range for this position is $32.00… more
    Actalent (10/01/25)
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  • Behavioral Health Utilization Review…

    Actalent (Sunrise, FL)
    Job Title: Behavioral Health Utilization Review NurseJob Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing requests ... the interdisciplinary team, the UMN handles tasks related to utilization review across various specialties, medical treatments,...on Tuesdays and will be logged into Teams for remote shadowing. Job Type & Location This is a… more
    Actalent (10/02/25)
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  • Utilization Management Nurse…

    CVS Health (FL)
    …healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant to join our remote team. **Key Responsibilities** + Apply ... some weekends and holidays, per URAC and client requirements. ** Remote Work Expectations** + This is a 100% ...experience in Nursing. + At least 1 year of Utilization Management experience in concurrent review or… more
    CVS Health (10/02/25)
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  • Associate Manager, Clinical Health Services…

    CVS Health (FL)
    …in non-compact states as needed. + 5+ years of acute experience as a Registered Nurse + 3+ years of Utilization Management experience + 3+ year(s) of Appeals ... on business needs) Travel Required up to 5% for meetings/audits. Location: 100% Remote (US only) **About Us** American Health Holding, Inc. (AHH), a division of… more
    CVS Health (10/02/25)
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  • Utilization Review Clinician…

    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 (10/01/25)
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  • Utilization Review Clinician - ABA

    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 ... Analyzes BH member data to improve quality and appropriate utilization of services + Interacts with BH healthcare providers...teams to review care services related to Applied Behavior Analysis Services… more
    Centene Corporation (09/18/25)
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  • SNF Utilization Management RN - Compact Rqd

    Humana (Tallahassee, FL)
    …Coordinator or discharge planner in an acute care setting + Previous experience in utilization management/ utilization review for a health plan or acute care ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...Weekly Hours: 40 + Travel: While this is a remote position, occasional travel to Humana's offices for training… more
    Humana (09/12/25)
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  • RN, Manager, Utilization Management Nursing

    Humana (Tallahassee, FL)
    … Nurse (RN) license in the state of Michigan. + Previous experience in utilization management and/or utilization review . + Minimum of two (2) years ... of our caring community and help us put health first** The Manager, Utilization Management Nursing (LTSS Utilization Management Leader) utilizes clinical nursing… more
    Humana (09/28/25)
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  • Disease Management Nurse - Remote

    Sharecare (Tallahassee, FL)
    … utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants for identification ... more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and...and to take the pre and post tests to review competency during orientation. Yearly competency tests are required… more
    Sharecare (09/13/25)
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  • Medical Claim Review Nurse (RN)

    Molina Healthcare (Tampa, FL)
    …SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years ... that has a current active unrestricted license This a remote role and can sit anywhere within the United...Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing clinical knowledge… more
    Molina Healthcare (09/06/25)
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