- 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 ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied… more
- CenterWell (Tallahassee, FL)
- …caring community and help us put health first** The Compliance Nurse 2 reviews utilization management activities and documentation to ensure adherence ... prevent and detect fraud, waste, and abuse. The Compliance Nurse 2 work assignments are varied and...experience a plus + Previous experience in chronic disease management , utilization management , case … more
- AdventHealth (Orlando, FL)
- …avoidance strategies including concurrent payer communications to resolve status disputes. The Utilization Management Nurse is accountable for a designated ... 32803 **The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse ...+ 3 years acute care clinical nursing experience + 2 years Utilization Management experience,… more
- 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 ... required in med surg or specialty area. + Managed Care experience preferred, especially Utilization Management . + Preference for those residing in EST or CST… more
- AdventHealth (Altamonte Springs, FL)
- …avoidance strategies including concurrent payer communications to resolve status disputes. The Utilization Management Nurse is accountable for a designated ... **The role you will contribute:** The role of the Utilization Management (UM) Registered Nurse ...plan, and/or best practice guidelines, on a continuing basis. 2 ) Performs pre-admission status recommendation in Emergency Department or… more
- 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 ... cover any weekend time if needed Preferred candidate with Utilization Management and leadership experience (Direct Reports)..., case management , care transition and/or disease management . + Minimum 2 years of healthcare… more
- Centene Corporation (Tallahassee, FL)
- …28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive ... Analyzes BH member data to improve quality and appropriate utilization of services + Provides education to providers members...of an Accredited School Nursing or Bachelor's degree and 2 - 4 years of related experience. License to… more
- ChenMed (Lakeland, FL)
- …We're rapidly expanding and we need great people to join our team. The Nurse Case Manager 2 (RN) is responsible for achieving positive patient outcomes ... post-acute facilities, as well as their home environments. The Nurse Case Manager 2 (RN) will also...experience required. + A minimum of 1 year of utilization review and/or case management , home health,… more
- ChenMed (Tampa, FL)
- …years' clinical work experience required. + A minimum of 1 year of utilization review and/or case management , home health, hospital discharge planning experience ... expanding and we need great people to join our team. The Acute Care Nurse is responsible for achieving positive patient outcomes, managing quality of care across the… more
- Actalent (Tampa, FL)
- …Nursing Facility). + 3 years of concurrent review experience and/or discharge planning. + 2 years of utilization review/ management experience. + 1 year of ... thinking skills under minimal supervision. + Commitment to quality and standards. + Utilization management experience. + Case management experience. +… more
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