• Utilization Review Case…

    Florida Health Care Plans, Inc. (Daytona Beach, FL)
    … Office Specialist provides clerical support to clinicians performing utilization review and case management for members hospitalized or receiving ... information, communicating electronically and telephonically, interpreting data, and time management to meet department timeframes. Individuals must have strong… more
    Florida Health Care Plans, Inc. (09/07/25)
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  • Clinical Case Manager, Behavioral Health

    CVS Health (Orlando, FL)
    …Worker (LCSW) **Preferred Qualifications** + Bilingual Spanish + Managed care/ utilization review experience + Case management and discharge planning ... + Applies and interprets applicable criteria and clinical guidelines, standardized case management plans, policies, procedures, and regulatory standards while… more
    CVS Health (09/10/25)
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  • Intensive Community Manager

    ChenMed (North Miami, FL)
    …promote continuity of care and cost effectiveness through the integrating and functions of case management , utilization review and discharge planning. ... LPN or other nursing discipline) required + A minimum of 7 years' utilization review / case management experience, including psychological aspects of care… more
    ChenMed (09/05/25)
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  • Utilization Review Specialist Sr.

    BayCare Health System (Tampa, FL)
    …Preferred Masters in Nursing or Business **Experience:** + Required 2 years in Utilization Review or + Required 2 years in Case Management or + Required ... foundation of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior responsibilities include:** + Functions… more
    BayCare Health System (08/26/25)
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  • Medical Management Coordinator, RN

    DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
    …care or health insurance environment. + Minimum 2 years of experience with pre-authorization, utilization review / management , case management , care ... and goals. + Clearly and succinctly documents necessary and/or required information in Utilization Management system. + Monitors and complies with all state,… more
    DOCTORS HEALTHCARE PLANS, INC. (08/26/25)
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  • National Accounts Medical Director

    Elevance Health (Miami, FL)
    …The medical director provides clinical expertise in all aspects of utilization review and case management . Provides input on the clinical relevance ... means that the medical director is directly involved in Utilization Management and Case ...state or territory of the United States when conducting utilization review or an appeals consideration and… more
    Elevance Health (08/27/25)
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  • RN Case Manager PRN

    HCA Healthcare (Ocala, FL)
    …RN experience required + 4 year Bachelor Degree preferred + Certification in Case Management or Utilization Review preferred + 1 year experience in acute ... while supporting a balance of optimal care and appropriate resource utilization . + Provides case management services for both inpatient and observation… more
    HCA Healthcare (08/09/25)
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  • RN Case Manager

    HCA Healthcare (Ocala, FL)
    …experience required + 4 year Bachelor Degree preferred. + Certification in Case Management or Utilization Review preferred HCA Florida Ocala Hospital is ... supporting a balance of optimal care and appropriate resource utilization . + Provides case management ...growth, we encourage you to apply for our RN Case Manager opening. We promptly review all… more
    HCA Healthcare (09/07/25)
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  • Clinical Audit and Appeals Consultant

    Intermountain Health (Tallahassee, FL)
    …settings or previous appeals experience. + Demonstrated experience in utilization review and/or case management , hospital insurance billing, third party ... in the court of law. **Essential Functions** + Uses nationally recognized evidence-based utilization review criteria (such as Milliman Care Guidelines (MCG) or… more
    Intermountain Health (09/08/25)
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  • RN Case Manager PRN

    HCA Healthcare (Jacksonville, FL)
    … Management is required for this PRN role. + Certification in Case Management or Utilization Review is preferred. + InterQual experience is preferred. ... will make appropriate referrals to third-party payer, disease and case management programs for recurring patients and...growth, we encourage you to apply for our RN Case Manager opening. We review all applications.… more
    HCA Healthcare (08/20/25)
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