• Encompass Health (Lake Worth, FL)
    …accuracy of discharge and payor-related information in the patient recordParticipate in utilization review process: data collection, trend review , and ... required documentation.Maintain knowledge of regulations/standards, company policies/procedures, and department operations. Review /analyze case management reports, including Key Care Indicators, and… more
    Talent (10/10/25)
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  • Behavioral Health Utilization Review

    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... Additional Skills & Qualifications + Current unrestricted Florida RN or LPN License. + Minimum of one year… more
    Actalent (10/10/25)
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  • Behavioral Health Utilization Review

    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,...health. + Proficiency in clinical and utilization review processes. + Current unrestricted Florida RN more
    Actalent (10/10/25)
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  • Utilization Review RN

    BayCare Health System (Tampa, FL)
    …appraisals + Community discounts and more Equal Opportunity Employer Veterans/Disabled **Position** Utilization Review RN **Location** Tampa:St Josephs | ... of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior/ RN responsibilities...+ **On Call:** No **Certifications and Licensures:** + Required RN ( Registered Nurse ) + Preferred… more
    BayCare Health System (10/10/25)
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  • Utilization Review Clinician…

    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 ... and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and… more
    Centene Corporation (10/01/25)
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  • Utilization Management Registered

    AdventHealth (Daytona Beach, FL)
    …32117 **The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse ( RN ) is to use clinical expertise by analyzing patient ... of admission; and when warranted by length of stay, utilization review plan, and/or best practice guidelines,...+ Current and valid license to practice as a Registered Nurse (ADN or BSN) required. +… more
    AdventHealth (09/18/25)
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  • SNF Utilization Management RN

    Humana (Tallahassee, FL)
    …an impact** **Use your skills to make an impact** **Required Qualifications** + **​Licensed Registered Nurse ( RN )** in the (appropriate state) with no ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...in an acute care setting + Previous experience in utilization management/ utilization review for a… more
    Humana (09/12/25)
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  • Medical Claim Review Nurse

    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 ... hours 6 AM to 6 PM (Team will work on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing… more
    Molina Healthcare (09/06/25)
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  • Care Review Clinician, PA ( RN )

    Molina Healthcare (Orlando, FL)
    …for internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse ( RN ). **Required Experience** 1-3 years of ... Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual… more
    Molina Healthcare (09/05/25)
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  • Registered Nurse RN Case Mgr…

    HCA Healthcare (West Palm Beach, FL)
    …compelling, we encourage you to apply for our Registered Nurse RN Case Mgr PRN opening. We promptly review all applications. Highly qualified candidates ... is recognized. Submit your application for the opportunity below: Registered Nurse RN Case Mgr...critical care experience + Certification in case management or utilization review preferred + InterQual experience preferred… more
    HCA Healthcare (09/12/25)
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  • Registered Nurse RN case Mgr

    HCA Healthcare (Margate, FL)
    …growth, we encourage you to apply for our Registered Nurse RN case Mgr opening. We promptly review all applications. Highly qualified candidates will ... **Introduction** Do you have the career opportunities as a(an) Registered Nurse RN case Mgr...critical care experience + Certification in case management or utilization review preferred + InterQual experience preferred… more
    HCA Healthcare (08/15/25)
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  • Registered Nurse Case Mgr RN

    HCA Healthcare (Aventura, FL)
    …HCA Healthcare colleagues invested over 156,000 hours volunteering in our communities. As a(an) Registered Nurse Case Mgr RN PRN with HCA Florida Aventura ... in our organization. We are looking for an enthusiastic Registered Nurse Case Mgr RN ...critical care experience + Certification in case management or utilization review preferred + InterQual experience preferred… more
    HCA Healthcare (08/09/25)
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  • Case Manager, Registered Nurse

    CVS Health (FL)
    …+ Perform medical necessity reviews. **Required Qualifications** + 5+ years' experience as a Registered Nurse with at least 1 year of experience in a hospital ... setting. + A Registered Nurse that holds an active, unrestricted...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
    CVS Health (10/02/25)
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  • Registered Nurse Case Mgr

    HCA Healthcare (Davie, FL)
    …Healthcare colleagues invested over 156,000 hours volunteering in our communities. As a(an) Registered Nurse Case Mgr with HCA Florida University Hospital you ... in our organization. We are looking for an enthusiastic Registered Nurse Case Mgr to help us...critical care experience + Certification in case management or utilization review preferred + InterQual experience preferred… more
    HCA Healthcare (09/26/25)
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  • Utilization Management Nurse

    CVS Health (Tallahassee, FL)
    …shift times are not permitted. **Required Qualifications** + Active unrestricted state Registered Nurse licensure in state of residence required. + Minimum ... high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant to join...experience in Nursing. + At least 1 year of Utilization Management experience in concurrent review or… more
    CVS Health (10/11/25)
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  • RN Case Manager Part Time

    HCA Healthcare (Tallahassee, FL)
    RN license** **required** **within** **90 days** **of hire** + **Advanced Practice Registered Nurse license is acceptable for** **position if current and ... supporting a balance of optimal care and appropriate resource utilization . The RN CM Care Coordinator will...compliant** + **Certification in Case Management, Nursing, or Utilization ** ** Review , preferred** + **Three years** **of**… more
    HCA Healthcare (10/05/25)
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  • RN Case Manager

    HCA Healthcare (Tallahassee, FL)
    …FL RN license required within 90 days of hire** + **Advanced Practice Registered Nurse license is acceptable for position if current and compliant** + ... supporting a balance of optimal care and appropriate resource utilization . The RN CM Care Coordinator will...**Certification in Case Management, Nursing, or Utilization Review , preferred** + **Three years of… more
    HCA Healthcare (09/21/25)
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  • Clinical Registered Nurse

    Cognizant (Tallahassee, FL)
    …to be considered** . Educational background - Registered Nurse ( RN ) . 2-3 years combined clinical and/or utilization management experience with managed ... Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact...as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral,… more
    Cognizant (10/07/25)
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  • Oncology Prior Authorization Case Manager, Non-…

    University of Miami (Miami, FL)
    …of UMHC SCCC Business Operations has an exciting opportunity for a full time Utilization Review Case Manager to work to work remote. The incumbent conducts ... initial, concurrent and retrospective chart reviews for clinical utilization and authorization. The Utilization Review...reviews for clinical utilization and authorization. The Utilization Review Case Manager coordinates with the… more
    University of Miami (09/25/25)
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  • Registered Nurse Cardiac Holding…

    HCA Healthcare (Panama City, FL)
    …encourage you to apply for our Registered Nurse Cardiac Holding RN opening. Our team will promptly review your application. Highly qualified candidates ... colleagues in their positions. Join our Team as a(an) Registered Nurse Cardiac Holding RN ...Hospital. Prioritizes and organizes patient flow to ensure best utilization of time. Is given general guidance and is… more
    HCA Healthcare (10/07/25)
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