- 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
- 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
- HCA Healthcare (Tallahassee, FL)
- …we support our colleagues in their positions. Join our Team as an Operating Room Nurse - Surgery Center and access programs to assist with every stage of your ... and job skills. Apply today for our Operating Room Nurse - Surgery Center opening and continue to learn!...the instrument and equipment set-up for your OR, including utilization of preference cards and ability to anticipate your… more
- Prime Therapeutics (Tallahassee, FL)
- …of post-degree clinical experience. + Experience in managed care, specialty drugs, care management and utilization review . + Meets Magellan Credentialing ... and drives every decision we make. **Job Posting Title** Infusion Referral Nurse - REMOTE **Job Description Summary** Under supervision, is responsible for performing… more
- Fresenius Medical Center (Tallahassee, FL)
- …auditing activities. + Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. + Manages clinic ... financials including efficient utilization of supplies or equipment and regular profits and...of supplies or equipment and regular profits and loss review . + Responsible for all required network reporting and… more
- Sedgwick (Tallahassee, FL)
- …and consult review ; and two (2) years of experience in daily application of nurse auditing, utilization review and bill review . **Skills & ... Great Place to Work(R) Most Loved Workplace(R) Forbes Best-in-State Employer RN Bill Review **PRIMARY PURPOSE** **:** To review hospital and professional medical… more
- CenterWell (Tallahassee, FL)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking...and reliable transportation. + Two years as a Registered Nurse with at least one-year of management … more