- Veterans Affairs, Veterans Health Administration (Bay Pines, FL)
- …of care. Follows procedures per established policies and guidelines. Responsibilities The Utilization Management (UM) Registered Nurse (RN) executes position ... comprehensive knowledge of clinical appropriateness, functions, processes, and principles of utilization management . Duties include but are not limited to:… 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)
- …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 EST zones.… 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...care and optimal resource use. Qualifications: + Degree in nursing or behavioral health field. + Active Florida license… more
- AdventHealth (Orlando, FL)
- …water, creating a holistic environment. **The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use clinical ... order or a status conflict is indicated, the UM nurse is responsible for escalation to the Physician Advisor... nursing experience required. + Minimum two years Utilization Management experience, or equivalent professional experience.… more
- Humana (Tallahassee, FL)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… 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 + Interqual + Milliman Commercial Guidelines… 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...management . Additional Skills & Qualifications + Degree in nursing or a related field in behavioral health. +… 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
- 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
- Centene Corporation (Tallahassee, FL)
- …licensed and located in FL. Ideal candidate will have experience in Utilization Management .** **Education/Experience:** Requires Graduate of an Accredited School ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… 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 ... and implement quality review programs and key performance indicators for all utilization review activities. + Interact with medical, nursing , and executive… 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
- Baylor Scott & White Health (Tallahassee, FL)
- **LOCATION:** Remote **SPECIALTY/DEPARTMENT:** Care Management : Case Management Utilization Management Appeals or grievances **SHIFT/SCHEDULE:** ... on position type and/or level **Job Summary** A Registered Nurse in Nursing Professional Development Generalist role...IN ONE OR MORE OF THE FOLLOWING SPECIALITIES:** **Case Management ** ** Utilization Management ** **Appeals or… more
- Molina Healthcare (FL)
- … and effective resource management . + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure ... IT and data analysts to produce tools to report, monitor and improve Utilization Management . + Actively participates in regulatory, professional and community… more
- Elevance Health (Miami, FL)
- …in multiple states. **Preferred Skills, Capabilities and Experience:** + Experience in Utilization Management and/or Long Term Care Services Strongly Preferred. ... for people enrolled in Medicaid and/or Medicare programs in Florida. **Medical Management Clinician Associate** **Location:** The candidate must reside in the state… more
- AdventHealth (Orlando, FL)
- …or Social Worker: BSW Masters in related field 3 years in direct Care Management / Utilization Management experience in an acute care setting **Preferred ... Debt-free Education (Certifications and Degrees without out-of-pocket tuition expense) + Nursing Clinical Ladder Program **Our promise to you:** Joining AdventHealth… more
- AdventHealth (Minneola, FL)
- …Social Worker: BSW Masters in related field - Required + 3 years direct Care Management / Utilization Management experience in an acute care setting - Required ... years of Manager level (or above) experience in Care Management Leadership + For RN - Registered Nurse... Management Leadership + For RN - Registered Nurse - State Licensure and/or Compact State Licensure State… more
- AdventHealth (Maitland, FL)
- …documents avoidable days, and facilitates progression of care. Collaborates with Utilization Management staff for collaboration on patient status changes ... Nursing (BSN) + Health-related Master's degree or MSN + Prior Care Management / Utilization Management experience + ACM/CCM Certification + Knowledge of… more
- Evolent (Tallahassee, FL)
- …As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts...or Oregon License Required** + Associate or Bachelors in Nursing (Must be a Registered Nurse ) -… more