- Actalent (Sunrise, FL)
- Job Title: Utilization Management NurseJob Description The Utilization Management Nurse (UMN) plays a crucial role in optimizing the utilization ... on department activities. Essential Skills + Clinical review + Utilization review + Utilization management + Interqual + Milliman Commercial Guidelines… more
- CVS Health (Tallahassee, FL)
- …constituents in the coordination and administration of the utilization /benefit management function. Required Qualifications + Registered Nurse in state of ... years of Nursing experience. Preferred Qualifications + Prior authorization utilization management /review experience preferred Outpatient Clinical experience. +… more
- CVS Health (Tallahassee, FL)
- …Must have active current and unrestricted RN licensure in state of residence. + Utilization Management is a 24/7 operation and work schedules will include ... in med surg or specialty area. + Managed Care experience preferred, especially Utilization Management . + Preference for those residing in ET zones. **Education**… more
- Ascension Health (Pensacola, FL)
- …and coordinate compliance to federally mandated and third party payer utilization management rules and regulations. **Requirements** Licensure / Certification ... offer._ **Responsibilities** Provide health care services regarding admissions, case management , discharge planning and utilization review. +.../ Registration: + Licensed Registered Nurse credentialed from the Florida Board of Nursing obtained… more
- Zurich NA (Tallahassee, FL)
- …+ Experience in development and implementation of cost containment programs + Case management , utilization review, catastrophic or disability experience + 5 or ... AVP, Utilization Review & Pharmacy 123092 Zurich Insurance is...recruiting and retaining team members. + Drive the performance management process by communicating job expectations, monitoring and evaluating… 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 ... Onsite Position Position Purpose: Works in partnership with physicians, nurse case managers, and other disciplines to ensure the...Florida. + 3 years minimum experience in discharge planning, utilization management , or case management .… more
- Elevance Health (Miami, FL)
- …and oversees program operations in support of corporate and health plan UM management . + Directs and collaborates with functional managers to develop and implement ... and monitors program schedule, budget, and resources plan. + Manages resource utilization to ensure appropriate delivery of care to members and adequate coverage… more
- Ascension Health (Pensacola, FL)
- …salary range at the time of the offer._ **Responsibilities** Manage effective utilization review processes, including management of patient statusing processes ... of utilization criteria, appeal and review process, and case management system documentation. + Conduct hiring, training, directing, development and evaluation… more
- Centene Corporation (Tallahassee, FL)
- …28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive ... Analyzes BH member data to improve quality and appropriate utilization of services + Provides education to providers members...Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- Centene Corporation (Tallahassee, FL)
- …28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive ... Analyzes BH member data to improve quality and appropriate utilization of services + Interacts with BH healthcare providers...Health Professional (LMHP) required or + RN - Registered Nurse - State Licensure and/or Compact State Licensure required… more
- ChenMed (North Miami Beach, FL)
- …years' clinical work experience required. + A minimum of 1 year of utilization review and/or case management , home health, hospital discharge planning experience ... expanding and we need great people to join our team. The Acute Care Nurse (RN) is responsible for achieving positive patient outcomes and managing quality of care… more
- ChenMed (Lakeland, FL)
- …years' clinical work experience required. + A minimum of 1 year of utilization review and/or case management , home health, hospital discharge planning experience ... we need great people to join our team. The Nurse Case Manager 2 (RN) is responsible for achieving...preferred providers. + Coordinate the integration of social services/case management functions in the pre-acute, ER, acute and post-acute… more
- Baylor Scott & White Health (Tallahassee, FL)
- **LOCATION:** Remote **SPECIALTY/DEPARTMENT:** Care Management : Case Management Utilization Management Appeals or grievances **SHIFT/SCHEDULE:** ... **PREFERRED RN EXPERIENCE IN ONE OR MORE OF THE FOLLOWING SPECIALITIES:** **Case Management ** ** Utilization Management ** **Appeals or grievances** As a… more
- Community Health Systems (Naples, FL)
- …coordinating and overseeing discharge planning, transitions of care, and case management activities to ensure optimal patient outcomes. This role involves ... to assess the appropriateness of admission, continued hospital stay, and utilization of diagnostic services. + Collaborates with interdisciplinary teams (IDT) to… more
- ChenMed (Tampa, FL)
- …minimum of 5 years' clinical work experience preferred + Proven working experience in Case Management : + A minimum of 2 years' utilization review and/or case ... our team. The Community Care team is a multidisciplinary service including Registered Nurse (RN) Community Care nurses, Licensed Practical Nurse (LPN) Community… more
- Veterans Affairs, Veterans Health Administration (Tampa, FL)
- Summary The James A Haley Veterans Hospital is looking for a Registered Nurse to work in the Oncology-Infusion Unit . This Registered Nurse possesses specialized ... function in caring for this Veteran population. Responsibilities The Oncology/Hematology Registered Nurse (RN) is responsible and accountable for all elements of the… more
- Veterans Affairs, Veterans Health Administration (Orlando, FL)
- …responsibility for the coordination of care focused on patient education, self- management , and customer satisfaction throughout the continuum of care. Administers ... members of the interdisciplinary team. Responsibilities The Inpatient Staff Registered Nurse (RN) is responsible for providing competent, evidence-based care to… more
- Veterans Affairs, Veterans Health Administration (Orlando, FL)
- Summary The Community Living Center (CLC) Admission Coordinator Registered Nurse (RN) is responsible for providing competent, evidence-based care to assigned ... of licensed vocational nurses/nursing assistants, as appropriate to the setting. The nurse will assist in directing the provision of nursing education, orientation,… more
- MyFlorida (Bunnell, FL)
- …recalls for client due for annual exams, implant removals and insertions. The Registered Nurse will provide case management for the sterilization program and the ... SENIOR REGISTERED NURSE - 64006662 Date: Jun 2, 2025 The...Knowledge, Skills, and Abilities: Knowledge, skills and abilities, including utilization of equipment, required for the position:Preferred or required… more
- MyFlorida (Land O' Lakes, FL)
- REGISTERED NURSE - 50000059 Date: Jun 2, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... . Requisition No: 853673 Agency: Veterans Affairs Working Title: REGISTERED NURSE - 50000059 Pay Plan: Career Service Position Number: 50000059 Salary:… more