- Actalent (Sunrise, FL)
- Utilization Management Nurse !Job Description The ...on department activities as assigned. Essential Skills + Clinical review + Utilization review + ... unrestricted Florida RN or LPN License. + Minimum of one year of utilization review experience and discharge planning in an acute care setting. + Four years… more
- Actalent (Sunrise, FL)
- Job Title: Behavioral Health Utilization Review SpecialistJob Description The Behavioral Health Utilization Review Specialist conducts comprehensive ... License (RN, or LMHC). + Minimum of two years of experience in utilization review /case management. + At least one year of experience in discharge planning within… more
- Ascension Health (Jacksonville, FL)
- …Provide health care services regarding admissions, case management, discharge planning and utilization review . + Review admissions and service requests ... planning needs with healthcare team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee and coordinate compliance… more
- Community Health Systems (Naples, FL)
- **Job Summary** Under the direction of the UR Director/Manager the UR Nurse reviews all admissions for medical necessity, correct orders based on medical condition ... improvement programs + Addresses facility and departmental communication through daily review of all correspondence, including incoming email messages. + Performs… more
- Veterans Affairs, Veterans Health Administration (Bay Pines, FL)
- …care. Follows procedures per established policies and guidelines. Responsibilities The Utilization Management (UM) Registered Nurse (RN) executes position ... demonstrate leadership, experience, and creative approaches to management of complex utilization processes. Practical experience in the application of UM methods and… more
- Actalent (Sunrise, FL)
- …+ Active Florida license (RN, LCSW, LMSW, LPHA, or LMHC). + 2+ years in utilization review /case management; 1+ year in acute care discharge planning preferred. + ... Utilization Management Behavioral Health ClinicianUtilization Management Behavioral Health...this role, you'll collaborate with an interdisciplinary team to review and authorize behavioral health and substance use services,… more
- Ascension Health (Pensacola, FL)
- **Details** + **Department: Utilization Review ** + **Schedule: Full time days** + **Hospital: Ascension Sacred Heart Pensacola** + **Location: Pensacola, ... salary range at the time of the offer._ **Responsibilities** Manage effective utilization review processes, including management of patient statusing processes… 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
- AdventHealth (Orlando, FL)
- …reviews within 24 hours of admission; and when warranted by length of stay, utilization review plan, and/or best practice guidelines, on a continuing basis. + ... environment. **The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is...to the Physician Advisor or designated leader for additional review as determined by department standards. Additionally, the UM… more
- Healthfirst (FL)
- **Duties/Responsibilities:** + Oversees utilization management functions which include timely authorizations related to pre-certification, concurrent review , ... reviews medical charts to obtain additional information required for appropriate utilization management and to solve complex clinical problems + Allocate, monitor,… more
- Veterans Affairs, Veterans Health Administration (Orlando, FL)
- Summary The Registered Nurse Peer Review QM Specialist at the Orlando VAMC primary responsibilities include performance improvement, ensuring compliance with ... Responsibilities The Peer Review Quality Management Specialist RN is a proficient nurse who understands a situation as a and perceives its meaning in terms of… more
- Actalent (Tampa, FL)
- Actalent is hiring a Clinical Review Nurse role! Job Description The Clinical Reviewer is a telephonic position responsible for recommending discharge plans, ... review experience and/or discharge planning. + 2 years of utilization review /management experience. Additional Skills & Qualifications + Current and… more
- ChenMed (North Miami Beach, FL)
- …assess and record patients' progress and adjust and plan accordingly. + Understanding utilization review and how to leverage with inpatient staff for possible ... great people to join our team. The Acute Care Nurse (RN) is responsible for achieving positive patient outcomes...experience required. + A minimum of 1 year of utilization review and/or case management, home health,… more
- Veterans Affairs, Veterans Health Administration (Pensacola, FL)
- …intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation requirements, ... Summary The incumbent is a Registered Nurse (RN) who serves as the Referral Coordinator...intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation… more
- MyFlorida (Land O' Lakes, FL)
- SENIOR LICENSED PRACTICAL NURSE - 50000083 Date: Jun 2, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... Requisition No: 853668 Agency: Veterans Affairs Working Title: SENIOR LICENSED PRACTICAL NURSE - 50000083 Pay Plan: Career Service Position Number: 50000083 Salary:… more
- Evolent (Tallahassee, FL)
- …Stay for the culture. **What You'll Be Doing:** Job Description As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We ... better health outcomes. **Collaboration Opportunities:** As a Clinical Reviewer, Nurse , you will routinely interact with leadership and management...You Will Be Doing:** + Functions in a clinical review capacity to evaluate all cases, which do not… more
- MyFlorida (Port Charlotte, FL)
- SENIOR REGISTERED NURSE SUPV - 50009035 Date: Jun 17, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... No: 855029 Agency: Veterans Affairs Working Title: SENIOR REGISTERED NURSE SUPV - 50009035 Pay Plan: Career Service Position...that the residents are receiving total nursing care. + Review shift assignments and ensure that the assignments reflect… more
- MyFlorida (Land O' Lakes, FL)
- SENIOR REGISTERED NURSE SUPV - 50000071 Date: Jun 12, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... . Requisition No: 853135 Agency: Veterans Affairs Working Title: SENIOR REGISTERED NURSE SUPV - 50000071 Pay Plan: Career Service Position Number: 50000071 Salary:… more
- MyFlorida (Orlando, FL)
- REGISTERED NURSE Date: Jun 11, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... . Requisition No: 845312 Agency: Veterans Affairs Working Title: REGISTERED NURSE Pay Plan: Career Service Position Number: 50009834 Salary: $66,414.40 Posting… more
- Veterans Affairs, Veterans Health Administration (Winter Park, FL)
- …intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation requirements, ... continuum of care. Responsibilities The Community Care (CC) Community Health Registered Nurse (RN) is responsible for executing a streamlined approach to receiving,… more