• Utilization Review RN…

    Baylor Scott & White Health (Tallahassee, FL)
    …priority. Note: Benefits may vary based on position type and/or level **Job Summary** As the Utilization Review RN you will review patient cases for ... provider's care coordination departments. Your expertise is needed to review medical necessity. Working with the team, you'll verify...experience is required. + You must hold a valid Registered Nurse License ( RN ). As… more
    Baylor Scott & White Health (07/23/25)
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  • Clinical Coding and OASIS Review Manager

    BAYADA Home Health Care (Orlando, FL)
    …with an industry leader. Apply now for immediate consideration. OASIS Review , Utilization Review , Quality Assurance, Remote , Home Health Coding, Coder, ... immediate opening for a **Full Time,** OASIS and Coding Review Manager with OASIS and Coding certification to work...Manager with OASIS and Coding certification to work remotely. RN , PT, OT, and SLP's with certifications will be… more
    BAYADA Home Health Care (07/01/25)
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  • Workers Compensation Support Registered…

    AdventHealth (Altamonte Springs, FL)
    …injuries and rehabilitation is essential **LICENSURE, CERTIFICATION, OR REGISTRATION REQUIRED:** + Active Registered Nurse ( RN ) license in the state of ... **Location:** Remote **The role youll contribute:** A Workers Comp Support Registered Nurse is responsible for providing telephonic medical case management… more
    AdventHealth (07/22/25)
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  • Ops Registered Nurse

    MyFlorida (Tallahassee, FL)
    OPS REGISTERED NURSE - 64937233 Date: Jul 8, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... . Requisition No: 854396 Agency: Department of Health Working Title: OPS REGISTERED NURSE - 64937233 Pay Plan: Health Care Practice Position… more
    MyFlorida (07/08/25)
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  • Supervisor, Intensive Community Care…

    ChenMed (Winter Park, FL)
    …or RN with Bachelor's Degree in related field preferred. + Must be a Registered Nurse with over three (3) years of clinical experience. + Compact license ... to join our team. The Supervisor, Intensive Community Care, RN is a multi-market leadership position responsible for leading...of 2 years' onsite case management at ChenMed and/or utilization review or discharge planning in a… more
    ChenMed (06/27/25)
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  • Utilization Review Clinician…

    Centene Corporation (Tallahassee, FL)
    …Family Therapist (LMFT) required or + Licensed Mental Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State ... Complies with all policies and standards **This is a remote position. We require candidates to be located and...abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with… more
    Centene Corporation (06/26/25)
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  • Utilization Review Nurse

    Actalent (Sunrise, FL)
    Utilization Management Nurse !Job Description The ...on department activities as assigned. Essential Skills + Clinical review + Utilization review + ... record Additional Skills & Qualifications + Current unrestricted Florida RN or LPN License. + Minimum of one year...or LPN License. + Minimum of one year of utilization review experience and discharge planning in… more
    Actalent (07/16/25)
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  • Utilization Management Nurse…

    CVS Health (Tallahassee, FL)
    …care **Preferred Qualifications** + NICU experience highly preferred + Managed care/ utilization review experience + Ability to multitask, prioritize and ... remote role open to candidates with an active RN licensure in the state in which they reside....to promote quality effectiveness of healthcare services and benefit utilization . **Required Qualifications** + Active and unrestricted RN… more
    CVS Health (07/22/25)
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  • Care Manager RN - ( Remote )

    Highmark Health (Tallahassee, FL)
    …Health **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health ... care services, application of criteria to ensure appropriate resource utilization , identification of opportunities for referral to a Health Coach/case management,… more
    Highmark Health (07/12/25)
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  • Clinical Appeals Nurse ( RN )

    Molina Healthcare (FL)
    **JOB DESCRIPTION** _For this position we are seeking a ( RN ) Registered Nurse who must be licensed for the state of UTAH or have a compact license._ _This ... Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support,… more
    Molina Healthcare (07/20/25)
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