- Elevance Health (Tampa, FL)
- Senior RN Utilization Review / Management (Acute InPatient) JR116937 **Location:** Must be within 50 miles / 1 hour commute of Tampa or Miami, FL offices. This ... Friday. **2 Holidays** per year and **occasional** weekends. The ** Nurse Medical Management Sr** serves as **team...preferred** . + 2 years of experience in In-Patient, utilization review / management , evaluating… more
- Centene Corporation (Tallahassee, FL)
- …assess ABA Treatment Plans preferred. Knowledge of ABA services and BH utilization review process preferred. Experience working with providers and healthcare ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- AdventHealth (Altamonte Springs, FL)
- …. Develops and implements case management programs and education, including utilization review , transitions of care, disease management , population ... Utilization will oversee ED, Inpatient, and Specialist utilization , and manage care management outcomes. The...in nursing with 4 years of experience. . Registered Nurse with an active and unrestricted license to practice… more
- Elevance Health (Tallahassee, FL)
- ** Utilization Management Representative II** **Location:** Must live within 50 miles of a Florida PulsePoint. The ** Utilization Management Representative ... provider on referrals given. + Refers cases requiring clinical review to a nurse reviewer; and handles...eligibility information. + May act as liaison between Medical Management and internal departments. Responds to telephone and written… more
- Centene Corporation (Tallahassee, FL)
- …findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and ... preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + LPN -… more
- ChenMed (St. Petersburg, FL)
- …of care and cost effectiveness through the integrating and functions of case management , utilization review and discharge planning. The incumbent in ... related field preferred + Valid, active licensure as professional nurse (RN, LPN or other nursing discipline) required +...nursing discipline) required + A minimum of 7 years' utilization review /case management experience, including… more
- AdventHealth (Altamonte Springs, FL)
- …Nursing OR Social Worker: BSW Two (2) years of experience in direct Care Management State specific RN license if a nurse **Preferred qualifications:** Registered ... visionary leadership and world-class resources **The role you'll contribute:** **The Care Management Supervisor is under the general leadership of the Care … more
- MyFlorida (Land O' Lakes, FL)
- SENIOR LICENSED PRACTICAL NURSE - 50000034 Date: Aug 28, 2024 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... Requisition No: 832463 Agency: Veterans Affairs Working Title: SENIOR LICENSED PRACTICAL NURSE - 50000034 Pay Plan: Career Service Position Number: 50000034 Salary:… more
- Elevance Health (Miami, FL)
- …**How you will make an impact:** + Develops, maintains, and enhances the claims review process. + Assists management with developing unit goals, policies, and ... Nurse Audit Lead - Carelon Payment Integrity **Location:**...responsible for identifying, monitoring, and analyzing aberrant patterns of utilization and/or fraudulent activities by healthcare providers through prepayment… more
- Veterans Affairs, Veterans Health Administration (Orlando, FL)
- …RN possesses intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation ... Summary The Orlando Healthcare System is recruiting for Referral Coordination Team (RCT) Registered Nurse (RN). The RCT RN serves as a liaison to both internal and… more
- MyFlorida (Macclenny, FL)
- SENIOR REGISTERED NURSE SUPV - 60022045 Date: Sep 21, 2024 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... 807710 Agency: Children and Families Working Title: SENIOR REGISTERED NURSE SUPV - 60022045 Position Number: 60022045 Salary: $2413.22...in office or unit as designated by supervisor for review of nursing services by inside or outside auditors.… more
- AdventHealth (Orlando, FL)
- …functions include but are not limited to performance of medical record review , utilization management , patient safety, compliance program, orientation ... addressing bill hold items related to the medical record review and quality process as assigned **The value you'll...use of comparative data, performance of specified audits and utilization management activities. + Serves as a… more
- Health First (Viera, FL)
- …Utilizes case-finding strategies to identify at-risk patients, such as unit rounds, utilization of computer reports, chart review , etc. Identifies educational ... nursing process to improve outcomes, to assure appropriate resource utilization , and support discharge planning and continuity of care...* Incontinence of the bowel and/or bladder The WOC nurse should be prepared to provide the full scope… more
- Immigration and Customs Enforcement (Miami, FL)
- …Corps (IHSC), Office of Deputy Assistant Director of Clinical Services (DAD-CSU). The Nurse Manager (NM) will report directly to the Regional Nurse Manager ... ensuring needed interpretation and/or translations services are available. Reviews utilization and documentation of translation services within the medical record,… more
- Matrix Providers (Jacksonville, FL)
- …TRICARE directives, coordinating with the local Medical Home Port (MHP) clinic, utilization and Referral Management policies, and obtains additional clinical ... Licensed Practical Nurse (LPN/LVN) -Naval Hospital Jacksonville, FL Location: Jacksonville,...Consult, coordinate, and collaborate with MHP team members, referral management team members, specialty care clinics, outside care professionals,… more
- MyFlorida (Daytona Beach, FL)
- REGISTERED NURSE - 50001657 Date: Aug 27, 2024 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... . Requisition No: 836292 Agency: Veterans Affairs Working Title: REGISTERED NURSE - 50001657 Pay Plan: Career Service Position Number: 50001657 Salary:… more
- AdventHealth (Apopka, FL)
- …documents avoidable days, and facilitates progression of care. Collaborates with Utilization Management staff for collaboration on patient status changes ... (as permitted by the patient) as well as a review of the current and past inpatient and outpatient...+ Health-related master's degree or MSN + Prior Care Management / Utilization Management experience +… more
- AdventHealth (Celebration, FL)
- …documents avoidable days, and facilitates progression of care. Collaborates with Utilization Management staff for collaboration on patient status changes ... (as permitted by the patient) as well as a review of the current and past inpatient and outpatient...+ Health-related master's degree or MSN + Prior Care Management / Utilization Management experience +… more
- MyFlorida (Chattahoochee, FL)
- REGISTERED NURSE SPECIALIST - F/C - 67056731 APD/ DDDP CHATTAHOOCHEE, FL Date: Sep 16, 2024 The State Personnel System is an E-Verify employer. For more information ... Agency: Agency for Persons with Disabilities Working Title: REGISTERED NURSE SPECIALIST - F/C - 67056731 APD/ DDDP CHATTAHOOCHEE,...dynamics. This position with APD will serve staff and management across the Agency. Your work will impact the… more
- AdventHealth (Altamonte Springs, FL)
- …experience *Experience in Case Management , Managed Care, Discharge Planning and Utilization Management *Case Management training *Specific knowledge and ... Scope and Standard for Nursing Practice, and the AONE Nurse Executive Competencies. *Liaises between Care Management ,...Avoids delay by ensuring test results are available for review and decision making. *Connects with hospital providers each… more