- Actalent (Sunrise, FL)
- Actalent is Hiring a Remote DietitianPosition Purpose: The Registered Dietitian will provide clinical education and support for Ambetter members enrolled in Disease ... + Backed by a non-clinical support team and market-level partnerships. Work Environment Remote Work Pay and Benefits The pay range for this position is $32.00… more
- Actalent (Sunrise, FL)
- …Utilization Review NurseJob Description We are seeking a dedicated Utilization Management Nurse (UMN) who will work collaboratively with an ... process development, and provide education to the team on utilization review -related issues. Responsibilities + Review...involving shadowing a team member on-site on Tuesdays and remote shadowing through Teams. Job Type & Location This… more
- Actalent (Sunrise, FL)
- Job Title: Behavioral Health Utilization Review NurseJob Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing requests ... the interdisciplinary team, the UMN handles tasks related to utilization review across various specialties, medical treatments,...on Tuesdays and will be logged into Teams for remote shadowing. Job Type & Location This is a… more
- Cognizant (Tallahassee, FL)
- …Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work related to clinical ... as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral,...Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan .… more
- CVS Health (Tallahassee, FL)
- …healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant to join our remote team. **Key Responsibilities** + Apply ... some weekends and holidays, per URAC and client requirements. ** Remote Work Expectations** + This is a 100% ...experience in Nursing. + At least 1 year of Utilization Management experience in concurrent review or… more
- Centene Corporation (Tallahassee, FL)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... a fresh perspective on workplace flexibility. **Position Purpose:** Performs a clinical review and assesses care related to mental health and substance abuse.… more
- Humana (Tallahassee, FL)
- …Coordinator or discharge planner in an acute care setting + Previous experience in utilization management/ utilization review for a health plan or acute care ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...Weekly Hours: 40 + Travel: While this is a remote position, occasional travel to Humana's offices for training… more
- Centene Corporation (Tallahassee, FL)
- …flexibility. **Must Reside in Florida!** **Centene is Hiring!** **We're looking for a Remote Concurrent Review Nurse to support our Medicaid team.** ... strong inpatient acute care bedside nursing experience** + **Brings a background in Utilization Management/ Review ** + **Holds an active nursing license** + **Is… more
- Sharecare (Tallahassee, FL)
- … utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants for identification ... more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and...and to take the pre and post tests to review competency during orientation. Yearly competency tests are required… more
- AdventHealth (Orlando, FL)
- **Quality Review Nurse RN PRN Home Care...through Friday 8:00 am to 5:00 pm **Location:** Virtual Remote near 602 COURTLAND ST, Orlando, FL, 32804 **The ... role you'll contribute:** Responsible for ensuring effective utilization and case management oversight activities as defined by interprofessional best practices and… more
- Highmark Health (Tallahassee, FL)
- …**Job Description :** **JOB SUMMARY** This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides ... to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, corporate, state, and… more
- Molina Healthcare (Tampa, FL)
- …SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years ... that has a current active unrestricted license This a remote role and can sit anywhere within the United...Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing clinical knowledge… more
- CVS Health (FL)
- …with transferring patients to lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC recognized accreditation preferred. + ... each and every day. **Position Summary** **This is a remote work from home role anywhere in the US...is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that… more
- Lincoln Financial (Tallahassee, FL)
- …Experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management preferred ... **Alternate Locations:** Work from Home **Work Arrangement:** Remote : Work at home employee residing outside...We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position… more
- Adecco US, Inc. (Tampa, FL)
- …setting. **PREFERRED QUALIFICATIONS** : + Previous comprehensive care continuum management, utilization review or discharge planning experience. + HMO experience ... the cost consequences resulting from care delivery decisions through utilization of reports and systems such as Health Plan...under proper scope of practice. + Ability to provide remote clinic coverage if needed. + Ability to travel… more