- CVS Health (Tallahassee, FL)
- …frontline advocates for members who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current case management ... the member to facilitate the member's overall wellness. Through the use of clinical tools and information/data review , conducts an evaluation of member's needs… more
- Public Consulting Group (Tallahassee, FL)
- …learn more, visit www.publicconsultinggroup.com . PCG is currently seeking a qualified Registered Nurse to perform as a Case Manager. The Case Manager will be ... providing case management services, assisting families and program recipients through prior approval of certain healthcare services, and collaborating with the… more
- Select Medical (Tallahassee, FL)
- …highly effective level of care. **Qualifications** **What we're looking for in a Clinical Liaison** **Required Skills:** + Registered Nurse (RN) or Respiratory ... License. + Will consider other designations like LPN, PT, OT etc., upon further review . + Ability to complete clinical assessments of medically complex patients.… more
- Prime Therapeutics (Tallahassee, FL)
- …Escalates medical exception requests to nurse , pharmacist or physician on the utilization review clinical team when further review is necessary. + Other ... using clinical criteria. Makes approval recommendations on all services that meet clinical review criteria. Refers all cases not meeting clinical … more
- Centene Corporation (Tallahassee, FL)
- …benefits including a fresh perspective on workplace flexibility. **Position Purpose:** Performs a clinical review and assesses care related to mental health and ... the applicable state required. Master's degree for behavioral health clinicians required. Clinical knowledge and ability to review and/or assess treatment plans… more
- Centene Corporation (Tallahassee, FL)
- …appropriate related to behavioral health (BH) and/or autism spectrum disorder needs and clinical standards + Performs prior authorization reviews related to BH ... (BCBA) required. Master's degree for behavioral health clinicians preferred. Behavioral health clinical knowledge and ability to review and/or assess ABA… more
- CenterWell (Tallahassee, FL)
- …gaps in care, ensuring timeless access to important medications and solving urgent clinical needs. We will be serving patients in Texas, Florida, and Mississippi and ... possible. Responsibilities: * Act as a collaborating physician for several nurse practitioners or physician assistants, including completing regular chart review… more
- Sedgwick (Tallahassee, FL)
- …Workplaces in Financial Services & Insurance RN Consultant Sr - Professional Liability ** Prior Legal Nurse Consulting expereince highly preferred in order to be ... Consultant) Certification or training preferred. **Experience** Five (5) years related clinical nursing experience and two (2) years nurse consultant experience… more