- Veterans Affairs, Veterans Health Administration (Bay Pines, FL)
- …policies and guidelines. Responsibilities The Utilization Management (UM) Registered Nurse ( RN ) executes position responsibilities that demonstrate ... knowledge of clinical appropriateness, functions, processes, and principles of utilization management . Duties include but are not...level degree in Nursing may have opportunity to become registered as a nurse with a state… more
- Healthfirst (FL)
- **Duties/Responsibilities:** + Oversees utilization management functions which include timely authorizations related to pre-certification, concurrent review, ... and reviews medical charts to obtain additional information required for appropriate utilization management and to solve complex clinical problems + Allocate,… more
- CVS Health (Tallahassee, FL)
- …active current and unrestricted RN licensure in state of residence. + Utilization Management is a 24/7 operation and work schedules will include weekends, ... **Required Qualifications** + 2+ years of experience as a Registered Nurse in adult acute care/critical care...or specialty area. + Managed Care experience preferred, especially Utilization Management . + Preference for those residing… more
- Actalent (Sunrise, FL)
- Utilization Management Behavioral Health ClinicianUtilization Management Behavioral Health Clinician We're seeking a dedicated Behavioral Health Clinician to ... join our Utilization Management team. In this role, you'll...nursing or behavioral health field. + Active Florida license ( RN , LCSW, LMSW, LPHA, or LMHC). + 2+ years… more
- AdventHealth (Orlando, FL)
- …**The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse ( RN ) is to use clinical expertise by analyzing patient ... and valid license to practice in Florida as a Registered Nurse (ADN or BSN) required. +...care clinical nursing experience required. + Minimum two years Utilization Management experience, or equivalent professional experience.… more
- Humana (Tallahassee, FL)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...skills to make an impact** **Required Qualifications** + Active Registered Nurse ( RN ) license in,… more
- Humana (Tallahassee, FL)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...+ Minimum of associate degree in nursing + Licensed Registered Nurse ( RN ) in a… more
- Ascension Health (Jacksonville, FL)
- **Details** + **Department:** Utilization Management + **Schedule:** Part Time; Every Saturday and Sunday; 7am - 7pm; Rotating holidays + **Hospital:** Ascension ... and coordinate compliance to federally mandated and third party payer utilization management rules and regulations. **Requirements** Licensure / Certification… more
- Actalent (Sunrise, FL)
- Utilization Management Nurse !Job Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing service authorization ... activities as assigned. Essential Skills + Clinical review + Utilization review + Utilization management ...record Additional Skills & Qualifications + Current unrestricted Florida RN or LPN License. + Minimum of one year… more
- Actalent (Sunrise, FL)
- …The Behavioral Health Utilization Review Specialist conducts comprehensive utilization management activities for behavioral health plan members. This ... assigned. Essential Skills + Proficiency in clinical review and utilization management . + Knowledge of Interqual and...field in behavioral health. + Current unrestricted Florida License ( RN , or LMHC). + Minimum of two years of… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …safe discharge coverage for all hospital units. + Participates in utilization management initiatives/opportunities for improvement through departmental committee ... assignments. Qualifications: + Registered Nurse or Licensed Practical Nurse...Florida. + 3 years minimum experience in discharge planning, utilization management , or case management .… more
- 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 ... licensed and located in FL. Ideal candidate will have experience in Utilization Management .** **Education/Experience:** Requires Graduate of an Accredited School… more
- Ascension Health (Pensacola, FL)
- …evaluation of staff. **Requirements** Licensure / Certification / Registration: + Licensed Registered Nurse credentialed from the Florida Department of Health ... salary range at the time of the offer._ **Responsibilities** Manage effective utilization review processes, including management of patient statusing processes… more
- AdventHealth (Maitland, FL)
- …documents avoidable days, and facilitates progression of care. Collaborates with Utilization Management staff for collaboration on patient status changes ... in Nursing (ASN) + Current valid license as a Registered Nurse in the state of Florida...+ Health-related Master's degree or MSN + Prior Care Management / Utilization Management experience + ACM/CCM… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …and goals. + Clearly and succinctly documents necessary and/or required information in Utilization Management system. + Monitors and complies with all state, ... subject matter expertise, as well as knowledge of the interconnection between Utilization Management , claims, and regulatory requirements to respond to complex… more
- AdventHealth (Orlando, FL)
- …+ Associate of Science degree in Nursing (ASN) + Current valid license as a Registered Nurse in the state of Florida + Two (2) years of medical/hospital ... satisfaction, patient safety, readmission prevention and length of stay management . The RN Care Manager communicates daily...+ Health-related Master's degree or MSN + Prior Care Management / Utilization Management experience + ACM/CCM… more
- Veterans Affairs, Veterans Health Administration (Pensacola, FL)
- Summary The incumbent is a Registered Nurse ( RN ) who serves as the Referral Coordinator for The Coordination Team at Gulf Coast Veterans Health Care System ... Administration (VHA) standards and guidelines. Responsibilities The Referral Coordination Team (RCT) Registered Nurse ( RN ) is responsible for executing a… more
- CVS Health (Tallahassee, FL)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year...Pharmacy or Oncology.** **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator… more
- CVS Health (Tallahassee, FL)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... reviews **Required Qualifications** - 5+ years' experience as a Registered Nurse with at least 1 year...using a keyboard **Preferred Qualifications** - 1+ years' Case Management experience or discharge planning, nurse navigator… more
- HCA Healthcare (Atlantis, FL)
- …patients with purpose and integrity. We care like family! Jump-start your career as a(an) Registered Nurse RN Case Mgr today with HCA Florida JFK Hospital. ... vary by location._** Come join our team as a(an) Registered Nurse RN Case Mgr....years of critical care experience + Certification in case management or utilization review preferred + InterQual… more