• Utilization Review Clinician

    Monte Nido (Miami, FL)
    …lives while providing the opportunity for people to realize their healthy selves. ** Utilization Review Clinician ** **Monte Nido** **Remote** **Monte Nido has ... to provide comprehensive care within an intimate home setting. We are seeking a Utilization Review Clinician to join our team based Remotely. **This is a… more
    Monte Nido (09/06/25)
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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 (07/31/25)
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  • Utilization Review Clinician…

    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 ... behavioral analytics (ABA). Additional Details: * Department: Behavioral Health Utilization Management * Business Unit: Corporate / Florida *...teams to review care services related to Applied Behavior Analysis Services… more
    Centene Corporation (08/23/25)
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  • Associate Medical Director

    CenterWell (Jacksonville, FL)
    …clinical performance in patient experience, quality of care, clinical outcomes, and avoidable utilization + Periodically review clinician charts to identify ... of health (SDOH) efforts, improving clinical outcomes and avoidable utilization + Monitor and manage daily patient care and...and monitor clinical & financial performance and metrics. + Review clinician schedules and incentive plans to… more
    CenterWell (07/22/25)
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  • Care Review Clinician , PA (RN)

    Molina Healthcare (Orlando, FL)
    …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... / MCG guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). MULTI STATE / COMPACT LICENSURE… more
    Molina Healthcare (09/05/25)
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  • Care Review Clinician (RN)

    Molina Healthcare (Miami, FL)
    …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... / MCG guidelines. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). MULTI STATE / COMPACT LICENSURE… more
    Molina Healthcare (08/20/25)
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  • Care Review Clinician , PA (RN)…

    Molina Healthcare (Miami, FL)
    …Experience Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... / MCG guidelines. To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal… more
    Molina Healthcare (08/23/25)
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  • Care Review Clinician (RN)

    Molina Healthcare (Orlando, FL)
    …or ER unit. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). To all current Molina employees: If ... you are interested in applying for this position, please apply through the intranet job listing. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $26.41 -… more
    Molina Healthcare (08/31/25)
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  • Medical Management Clinician Associate

    Elevance Health (Tampa, FL)
    …or equivalent. + Requires a minimum of 2 years of clinical experience and/or utilization review experience. + Current active, valid and unrestricted LPN/LVN or ... people enrolled in Medicaid and/or Medicare programs in Florida. **Medical Management Clinician Associate** **Location:** The candidate must reside in the state of… more
    Elevance Health (09/06/25)
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  • Non-Clinical Coding and OASIS Review…

    BAYADA Home Health Care (Orlando, FL)
    …+ Candidates should be available Monday-Friday from 8:30am-5:00pm. _Medicare, Coder, OASIS Review , Utilization Review , Quality Assurance, Remote, Home Health ... Review and communicate OASIS edit recommendations to each clinician to promote OASIS accuracy. + Perform final review and lock OASIS. + Timely review and… more
    BAYADA Home Health Care (08/15/25)
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