- 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 ... hiring!** **We're looking for two remote Supervisors of Behavioral Health Utilization Management to support our Florida market. In this leadership role, you'll… more
- CVS Health (Tallahassee, FL)
- …anywhere in the state of Florida. **Applicant must reside in Florida** . As a Utilization Management Nurse Consultant, you will utilize clinical skills to ... all with heart, each and every day. **Position Summary** Utilization Management is a 24/7 operation and...setting required - Must have active current and unrestricted RN licensure in state of Florida - Willingness to… more
- CVS Health (Tallahassee, FL)
- …active current and unrestricted RN licensure in state of residence. + Utilization Management is a 24/7 operation and work schedules will include weekends, ... **Required Qualifications** + 2+ years of experience as a Registered Nurse in adult acute care/critical care...or specialty area. + Managed Care experience preferred, especially Utilization Management . + Preference for those residing… more
- Humana (Tallahassee, FL)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...a resume with your application. **Required Qualifications** + Active Registered Nurse ( RN ) license in… more
- Humana (Tallahassee, FL)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work...skills to make an impact** **Required Qualifications** + Licensed Registered Nurse ( RN ) in an… more
- MTC (Quincy, FL)
- …record or other forms as appropriate. + Practice basic cost containment and utilization management for inmate care and facility operations. + Maintain absolute ... in one package!** Are you a dedicated and skilled RN looking for a meaningful opportunity to provide exceptional...with an acceptable driving record required, unless waived by management . Management & Training Corporation (MTC) is… more
- HCA Healthcare (Tallahassee, FL)
- …and assess observation patients for appropriateness in observation status + Performs utilization management reviews and communicates information to third party ... medical necessity, admission status, level of care, and resource management . The RN CM Care Coordinator will...supporting a balance of optimal care and appropriate resource utilization . The RN CM Care Coordinator will… more
- Highmark Health (Tallahassee, FL)
- …Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or ... required depending on where clinical care is being provided. **Preferred** + Certification in utilization management or a related field + Certification in Case … more
- Sharecare (Tallahassee, FL)
- …cost effective, appropriate resource utilization and quality outcomes. The Clinical Registered Nurse is also responsible for early identification of those ... according to the disease management program intervention guidelines. A Clinical Registered Nurse is supervised by an Operations Manager (OM). All Sharecare… more
- CVS Health (Tallahassee, FL)
- …outcomes through assessment and evaluation. **Required Qualifications** - Active and unrestricted compact Registered Nurse ( RN ) licensure and live in compact ... providers. Serves as advocate for patients, ensuring effective communication, resource utilization , and continuous monitoring of their progress to promote positive… more
- Evolent (Tallahassee, FL)
- …in Nursing (Must be a Registered Nurse ) + Experience as an RN in a Pain Management setting is preferred + Strong interpersonal and communication skills ... , you will be a key member of the utilization management team. We can offer you...Nurse , you will routinely interact with leadership and management staff, other CR's (Clinical Reviewers), providers, office staff… more
- Centene Corporation (Tallahassee, FL)
- …Bachelor's degree in Nursing and 4 - 6 years of related experience. **License/Certification:** + RN - Registered Nurse - State Licensure and/or Compact State ... Case Management experience strongly preferred. Home health experience and utilization management a plus.** **Position Purpose:** Assesses, plans, and… more
- Evolent (Tallahassee, FL)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... Be Doing:** + Practices and maintains the principles of utilization management and appeals management ...and Preferred:** + 1-3 years' experience and as an RN - **Required** + Minimum of 5 years in… more
- 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 ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- Lincoln Financial (Tallahassee, FL)
- …as indicated **What we're looking for** * 4 Year/Bachelor's Degree in Nursing * Registered Nurse License - Current, unrestricted license in the state where the ... We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position...Care, , Trauma , Disability, Workman's comp or case management or Utilization review **Application Deadline** **What's… more
- Guardian Life (Tallahassee, FL)
- …services. Act as a liaison between all parties required in case management to facilitate collaboration toward RTW goals. Utilization of independent ... **Position Summary** The RN Clinical Consultant serves as a clinical resource...plan and length of disability. Plan for ongoing case management through proactive partnering with treating providers to move… more
- HCA Healthcare (Tallahassee, FL)
- …PALS Pediatric Adv Life Supt must be obtained within 30 days of employment start date + Registered Nurse , or Advance Practice Registered Nurse (APRN) + ... work to deliver clinical excellence behind the scenes in data science, case management or transfer centers. Unlock your potential at HCA Florida Capital Hospital!… more
- CenterWell (Tallahassee, FL)
- …for managing populations and coordinating care to reduce acute and post-acute care utilization . The Divisional Director role is a hybrid with travel requirements to ... understanding and creating solutions that will lead to acute and post-acute care utilization reductions aligned with the PCO's objectives and goals. As a guideline,… more
- Highmark Health (Tallahassee, FL)
- …+ Master's degree in Business or Clinical field **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse ( RN ) or Pharmacist (Pharm D) or Physician ... **SKILLS** + Deep Clincal Expertise -extensive knowledge of clinical, quality, care, utilization , high-cost claim, and population health management . Must be a… more
- Evolent (Tallahassee, FL)
- …+ Performs other duties as assigned. **Qualifications: Required and Preferred:** + Licensed registered nurse or LVN/LPN (current and unrestricted) + Minimum of ... refers quality issues to the Senior Director of Medical Management or Medical Director. + Appropriately identifies potential cases...patient care + **Minimum one year of experience with Utilization Review (UM) in a managed care environment** +… more