- CVS Health (Tallahassee, FL)
- …And we do it all with heart, each and every day. **Position Summary:** The ** Utilization Management Clinical Nurse Consultant - Prior Authorization** ... internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and… more
- Humana (Tallahassee, FL)
- …help us put health first** Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Cognizant (Tallahassee, FL)
- …. Educational background - Registered Nurse (RN) . 2-3 years combined clinical and/or utilization management experience with managed health care plan ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations . Experience in utilization management to include Clinical … 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, ... determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent… more
- CVS Health (Tallahassee, FL)
- … solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse Consultant to join our remote team. ... listening, and use of a computer. + Flexibility to provide coverage for other Utilization Management (UM) Nurses across various UM specialty teams as needed,… more
- CVS Health (Tallahassee, FL)
- …internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and ... skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Applies critical thinking and knowledge in… more
- Centene Corporation (Tallahassee, FL)
- …in applied behavioral analytics (ABA). Additional Details: * Department: Behavioral Health Utilization Management * Business Unit: Corporate / Florida * ... changes everything for our 28 million members as a clinical professional on our Medical Management /Health Services...Analyzes BH member data to improve quality and appropriate utilization of services + Interacts with BH healthcare providers… more
- Centene Corporation (Tallahassee, FL)
- …be the one who changes everything for our 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, ... on workplace flexibility. **Florida Residency Required** **Position Purpose:** Performs a clinical review and assesses care related to mental health and substance… more
- Evolent (Tallahassee, FL)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are ... independent nursing judgement and decision-making, physician-developed medical policies, and clinical decision-making criteria sets. Acts as a member advocate by… more
- Sharecare (Tallahassee, FL)
- …helps to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during ... for everyone. To learn more, visit www.sharecare.com . **Job Summary:** The Disease Management Nurse has the responsibility for supporting the goals and… more
- CVS Health (Tallahassee, FL)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... self-insured clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures… more
- Highmark Health (Tallahassee, FL)
- …Degree in Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical , case/ utilization management and/or disease/condition management ... panel of members that range in health status/severity and clinical needs; and assesses health management needs...first 6 months of employment. **Preferred** + Certification in utilization management or a related field +… more
- HCA Healthcare (Tallahassee, FL)
- …passionate about delivering patient-centered care?** Submit your application for Operating Room Nurse - Surgery Center position and spend more time at the bedside ... shape business and operational outcomes, or work to deliver clinical excellence behind the scenes in data science, case... excellence behind the scenes in data science, case management or transfer centers. Unlock your potential at Tallahassee… 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 ... accomplishments. **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
- CenterWell (Tallahassee, FL)
- …Tallahassee, FL **This position comes with a $15K sign-on bonus.** The ** Clinical Manager** coordinates and oversees all direct care patient services provided by ... clinical personnel. + Develops, plans, implements, analyzes, and organizes clinical operations for a specific location managed. + Conducts/delegates the… more
- HCA Healthcare (Tallahassee, FL)
- **Description** **Introduction** Do you have the career opportunities as a(an) Manager Case Management you want in your current role? We invest in what matters most ... and accountability in ensuring all admissions and continued stays meet clinical criteria for appropriateness and medical necessity. Assesses discharge planning needs… 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 needs of assigned patients + Develops a case management plan of care to include identified clinical...position if current and compliant** + **Certification in Case Management , Nursing, or Utilization Review, preferred** +… more
- Highmark Health (Tallahassee, FL)
- …timeframes and notification requirements are met. + Communicate effectively with Utilization Management Staff, providers, other internal and external customers ... requirements. Documents, processes and routes requests for services to the nurse reviewer and other departments based on documentation procedures, including review… more
- Select Medical (Tallahassee, FL)
- … within the plan of care. + Demonstrates compliance with facility-wide Utilization Management policies and procedures. + Coordinates UR compliance with ... **Case Manager (PRN)** _Requires a current licensure in a clinical discipline either as a Nurse or...what is right. The Case Manager is responsible for utilization reviews and resource management , discharge planning,… more
- Select Medical (Tallahassee, FL)
- … within the plan of care. + Demonstrates compliance with facility-wide Utilization Management policies and procedures. + Coordinates UR compliance with ... Time: Monday-Friday 8-5pm** _Requires a current licensure in a clinical discipline either as a Nurse (RN/LPN/LVN)...what is right. The Case Manager is responsible for utilization reviews and resource management , discharge planning,… more