• Utilization Management Nurse…

    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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
    Humana (05/10/25)
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  • Utilization Management RN Registered…

    AdventHealth (Orlando, FL)
    …avoidance strategies including concurrent payer communications to resolve status disputes. The Utilization Management Nurse is accountable for a designated ... ROLLINS STREET, Orlando, 32803 **The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use clinical expertise… more
    AdventHealth (05/10/25)
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  • Utilization Management Nurse…

    CVS Health (Tallahassee, FL)
    …constituents in the coordination and administration of the utilization /benefit management function. Required Qualifications + Registered Nurse in state of ... years of Nursing experience. Preferred Qualifications + Prior authorization utilization management /review experience preferred Outpatient Clinical experience. +… more
    CVS Health (05/04/25)
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  • Utilization Management Nurse…

    CVS Health (Tallahassee, FL)
    …Must have active current and unrestricted RN licensure in state of residence. + Utilization Management is a 24/7 operation and work schedules will include ... med surg or specialty area. + Managed Care experience preferred, especially Utilization Management . + Preference for those residing in EST or CST zones.… more
    CVS Health (05/10/25)
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  • Utilization Management Nurse…

    CVS Health (Tallahassee, FL)
    …Must be willing and able to work Monday through Friday, 8:00am to 5:00pm. Utilization management is a 24/7 operation. Work schedules will include weekend/holiday ... zone + 3+ years of experience as a Registered Nurse + 3+ years of clinical experience required +...+ Managed Care experience + Discharge planning experience + Utilization Management experience **Education** Associates Degree or… more
    CVS Health (05/02/25)
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  • Utilization Management RN Remote

    AdventHealth (Altamonte Springs, FL)
    …avoidance strategies including concurrent payer communications to resolve status disputes. The Utilization Management Nurse is accountable for a designated ... **Job Location** : Remote **The role you will contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use clinical expertise by… more
    AdventHealth (05/03/25)
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  • Senior Compliance Registered Nurse

    Humana (Tallahassee, FL)
    …of our caring community and help us put health first** The Senior Compliance Nurse reviews utilization management activities and documentation to ensure ... and detect fraud, waste, and abuse. The Senior Compliance Nurse work assignments involve moderately complex to complex issues...action + Minimum two, (2) years of experience in utilization management + Intermediate proficiency using Microsoft… more
    Humana (05/06/25)
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  • Compliance Nurse 2

    CenterWell (Tallahassee, FL)
    …a part of our caring community and help us put health first** The Compliance Nurse 2 reviews utilization management activities and documentation to ensure ... prevent and detect fraud, waste, and abuse. The Compliance Nurse 2 work assignments are varied and frequently require...experience a plus + Previous experience in chronic disease management , utilization management , case … more
    CenterWell (05/08/25)
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  • RN Manager Healthcare Services…

    Molina Healthcare (Jacksonville, FL)
    …state they reside. We are looking for a RN Manager to manage a utilization management team supporting 14 Marketplace plans. Home office with internet ... - Flexibility to cover any weekend time if needed Preferred candidate with Utilization Management and leadership experience (Direct Reports) Compact RN license… more
    Molina Healthcare (05/10/25)
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  • Senior Accreditation Utilization…

    Humana (Tallahassee, FL)
    …+ Minimum 3 years of experience in NCQA Health Plan Accreditation and/or Utilization Management + Exceptional attention to detail. + Demonstrated excellent time ... + Expertise on NCQA accreditation standards, especially related to Utilization Management and/or Behavioral Health; MED-Deeming accreditation standards… more
    Humana (05/09/25)
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