- Actalent (Tampa, FL)
- …complete cases. Qualifications: + 3+ years of utilization management, concurrent review , prior authorization, utilization review , case management, and ... Urgent Hiring for " Remote Clinical Review Nurses" Job Description: + Review approximately 20 cases a day for medical necessity. + Advocate for and protect… more
- Humana (Tallahassee, FL)
- …Coordinator or discharge planner in an acute care setting + Previous experience in utilization management/ utilization review for a health plan or acute care ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...Weekly Hours: 40 + Travel: While this is a remote position, occasional travel to Humana's offices for training… more
- Molina Healthcare (Miami, FL)
- …At least 2 years clinical nursing experience, including at least 1 year of utilization review , medical claims review , long-term services and supports (LTSS), ... **Job Summary** Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory… more
- CVS Health (Tallahassee, FL)
- …with transferring patients to lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC recognized accreditation preferred. + ... each and every day. **Position Summary** **This is a remote work from home role anywhere in the US...is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that… more
- Highmark Health (Tallahassee, FL)
- …**Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides ... to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, corporate, state, and… more
- Battelle Memorial Institute (Eglin AFB, FL)
- …within legal and professional parameters + Knowledge and skill in using pre-established utilization review criteria to recognize and report actual or potential ... (HRA) business line is seeking a highly motivated, full-time ** Nurse Case Manager** to join our team in support...model allows you to work 60% in-office and 40% remote , with Monday and Tuesday as common in-office days,… more
- Evolent (Tallahassee, FL)
- …the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
- MyFlorida (Sanford, FL)
- OPS REGISTERED NURSE - 64858505 Date: Jan 7, 2026 The...Seminole County 400 W. Airport Blvd Sanford, FL 32773 Remote work will not be a consideration . The ... . Requisition No: 865084 Agency: Department of Health Working Title: OPS REGISTERED NURSE - 64858505 Pay Plan: Temp Position Number: 64858505 Salary: $32.00 hourly… more
- Molina Healthcare (Orlando, FL)
- For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity of ... on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. JOB DESCRIPTION Job SummaryProvides support for clinical member… more
- Oracle (Tallahassee, FL)
- …(ECD) alignments, Critical Care workflow implementation, Multi-Disciplinary Rounding, and various nurse chart review and documentation optimizations. The ideal ... a prominent academic medical center in the Midwest. This remote role will act as the primary subject matter...offer ongoing consultation to support user proficiency and system utilization . Monitor project outcomes, track key metrics, and report… more
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