- Health First (Melbourne, FL)
- …vehicle. **Job:** **Case Management * **Organization:** **Holmes Regional Medical Center* **Title:** * Utilization Review Nurse - Case Management UR ... *POSITION SUMMARY* The Utilization Review (UR) nurse ...as necessary. 7. Is an active member of the Utilization Management Committee. *MINIMUM QUALIFICATIONS* *Education:*Associate's Degree… more
- Actalent (Tampa, FL)
- Job Title: Utilization Review - Post Acute Care Job Description Our PAC Nurse is a telephonic role responsible for recommending discharge plans, assisting ... assigned and non-assigned post-acute care (PAC) facilities. The PAC Nurse will collaborate with key facility personnel and internal...Hard Skills + Discharge planning + Transition of care management + Length of stay management +… more
- Conviva (Tallahassee, FL)
- …to others. Preferred Locations: Daytona, FL, Louisville, KY, San Antonio, TX The Utilization Management Nurse utilizes clinical nursing skills to support ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse work assignments are varied… more
- Elevance Health (Miami, FL)
- **Clinical Operations Medical Director** ** Utilization Management of Medical Oncology Benefits** **Carelon Benefits Management ** **$20,000 Sign On Bonus** ... members and providers. **Job Summary:** + Perform physician-level case review , following initial nurse review ,...maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care. + Participate… more
- Centene Corporation (Tallahassee, FL)
- …IS MONDAY-FRIDAY, 8AM - 5PM. THESE ROLES WILL BE SUPPORTING BEHAVIORAL HEALTH UTILIZATION MANAGEMENT FOR MEDICAID. **Position Purpose:** Performs a clinical ... PROGRAM:** The UM role will be focusing on outlier management review of provider records with an...abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with… 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 ... 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 Group (Tallahassee, FL)
- …Experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or nurse case management ... Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible for… more
- Universal Health Services (Jacksonville, FL)
- …a whole. We are pleased to announce the following available position: PRN Utilization Review Coordinator This position is responsible for monitoring the ... Nurse , LPN or Master's level Social Worker with experience in Utilization Management , preferred. Good communication (verbal and written) skills are… more
- Cleveland Clinic (Stuart, FL)
- …Experience:** + Requires three years equivalent full-time clinical experience as a Registered Nurse . + Prior Utilization Management experience is preferred. ... but also a home away from home. As a Utilization Management (UM) RN Reviewer, you will...years of experience working in a hospital. * Has utilization review experience. * Demonstrates strong critical… more
- Cleveland Clinic (Weston, FL)
- …Miami-Fort Lauderdale metro area and remains a top hospital in Florida. As a Utilization Management (UM) Specialist, you will work under the general supervision ... Team Manager to perform UM activities which include admission review , concurrent review , retrospective chart review...*Achieves a minimum of 85% on IRR quarterly. *Completes Utilization Management for assigned patients with a… more
- YesCare Corp (Bartow, FL)
- …Veterans._ **Responsibilities** Below is a list of your responsibilities as a ** Utilization Management Coordinator** with YesCare: + Confirms admissions with ... outside hospitals and notifies the Utilization Management Department of need to report...to arrange discharge plan + Coordinates with the hospital utilization nurse to expedite discharge and avoid… more
- Elevance Health (Tampa, FL)
- …and depression, and insightful analytics to improve the delivery of care. The Utilization Management Representative I is responsible for coordinating cases for ... prior authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer. + Responsible for the identification… more
- Centene Corporation (Tallahassee, FL)
- …position requires a current Florida residency!!** **Centene is currently seeking a remote Clinical Review Nurse - Prior Authorization to join our team. This role ... possess a nursing license, have experience with Durable Medical Equipment (DME) and utilization management , and have a solid foundation in hands-on patient… more
- HCA Healthcare (Sanford, FL)
- …experience in Case Management + BSN is preferred + Certification in Case Management , Nursing or Utilization Review is preferred HCA Florida Lake Monroe ... patients, families, hospital staff, and outside agencies + Performs utilization management reviews and communicates information to...to apply for our Registered Nurse Case Management PRN opening. Our team will promptly review… more
- University of Miami (Miami, FL)
- …. This position functions as Manager of the Case Managers and Utilization Review for all inpatient UMHC facilities under the direction ... action plans for continuous improvement, maintains and creates reports for the Utilization Management Committee Meetings. The manager will assume the oversight… more
- ChenMed (Jacksonville, FL)
- …of care and cost effectiveness through the integrating and functions of case management , utilization review and discharge planning. The incumbent in ... related field preferred + Valid, active licensure as professional nurse (RN, LPN or other nursing discipline) required +...nursing discipline) required + A minimum of 7 years' utilization review /case management experience, including… more
- ChenMed (Orlando, FL)
- …of 2 years' clinical work experience required. + A minimum of 1 year of utilization review and/or case management , home health, hospital discharge planning ... need great people to join our team. The Acute Nurse Case Manager is responsible for achieving positive patient...patients' progress and adjust and plan accordingly. + Understanding utilization review and how to leverage with… more
- AdventHealth (Maitland, FL)
- …Nursing OR Social Worker: BSW Two (2) years of experience in direct Care Management State specific RN license if a nurse **Preferred qualifications:** Registered ... : 900 Winderley Place, Maitland, FL 32751 **The role you'll contribute:** **The Care Management Supervisor is under the general leadership of the Care Management … more
- The Arora Group (Jacksonville, FL)
- …by DOD, BUMED, and TRICARE directives, coordinating with the local MHP clinic, utilization and Referral Management policies, and obtains additional clinical data ... Licensed Practical Nurse (LPN/LVN) Nurse Currently recruiting a...Naval Hospital Jacksonville as part of the Comprehensive Pain Management Program. The primary site of service shall be… more
- MyFlorida (Land O' Lakes, FL)
- SENIOR LICENSED PRACTICAL NURSE - 50000086 1 Date: Jun 19, 2024 Location: LAND O' LAKES, FL, US, 34639 The State Personnel System is an E-Verify employer. For more ... Requisition No: 819687 Agency: Veterans Affairs Working Title: SENIOR LICENSED PRACTICAL NURSE - 50000086 1 Pay Plan: Career Service Position Number: 50000086… more