- Community Health Systems (Naples, FL)
- …written and verbal communication skills. **Licenses and Certifications** + RN - Registered Nurse - State Licensure and/or Compact State Licensure Current ... **Job Summary** Under the direction of the UR Director/Manager the UR Nurse reviews all admissions for medical necessity, correct orders based on medical condition… more
- Ascension Health (Pensacola, FL)
- **Details** **Department: Utilization Review ** **Schedule: M-F 0800-1630 with rotating Holidays** **Hospital: Ascension Sacred Heart Pensacola** **Location: ... Provide health care services regarding admissions, case management, discharge planning and utilization review . + Review admissions and service requests… more
- Veterans Affairs, Veterans Health Administration (Gainesville, FL)
- Summary The Utilization Management (UM) Registered Nurse (RN) is responsible for UM reviews for patients who receive hospital care. Responsibilities An UM ... Registered Nurse is responsible for UM reviews...in NUMI following VACO UM process and then InterQual review process. Facilitates and coordinates admissions to the most… more
- Humana (Tallahassee, FL)
- …skills to make an impact** **Required Qualifications** + Compact licensure + Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary ... of our caring community and help us put health first** The SNF Utilization Management Nurse uses clinical knowledge, communication skills, and independent… more
- CVS Health (Tallahassee, FL)
- …and administration of the utilization /benefit management function. Required Qualifications + Registered Nurse in state of residence. + 3+ years of Nursing ... experience. Preferred Qualifications + Prior authorization utilization management/ review experience preferred Outpatient Clinical experience. + Knowledge of… more
- Zurich NA (Tallahassee, FL)
- AVP, Utilization Review & Pharmacy 123092 Zurich Insurance is seeking an AVP, Utilization Review & Pharmacy. This is a fully remote position, offering ... flexibility of a home-based office. As the AVP of Utilization Review & Pharmacy, you will lead...more years of experience in the Nursing areaAND + Registered Professional Nurse license in residential area… more
- Ascension Health (Pensacola, FL)
- **Details** + **Department: Utilization Review ** + **Schedule: Full time days** + **Hospital: Ascension Sacred Heart Pensacola** + **Location: Pensacola, ... salary range at the time of the offer._ **Responsibilities** Manage effective utilization review processes, including management of patient statusing processes… 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 ... perspective on workplace flexibility. **Position Purpose:** Performs a clinical review and assesses care related to mental health and...Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact… more
- ChenMed (North Miami Beach, FL)
- …assess and record patients' progress and adjust and plan accordingly. + Understanding utilization review and how to leverage with inpatient staff for possible ... a related clinical field preferred. + A valid, active Registered Nurse (RN) license in State of...experience required. + A minimum of 1 year of utilization review and/or case management, home health,… 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 ... Analyzes BH member data to improve quality and appropriate utilization of services + Interacts with BH healthcare providers...Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact… more