- AdventHealth (Orlando, FL)
- …a holistic environment. **The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use clinical expertise by ... and valid license to practice in Florida as a Registered Nurse (ADN or BSN) required. +...care clinical nursing experience required. + Minimum two years Utilization Management experience, or equivalent professional experience.… more
- MyFlorida (Orlando, FL)
- REGISTERED NURSE Date: Nov 2, 2025 The...Plans and MDS as required. + Will ensure economic utilization of supplies and proper charging of items to residents' ... . Requisition No: 860343 Agency: Veterans Affairs Working Title: REGISTERED NURSE Pay Plan: Career Service Position Number:… more
- AdventHealth (Orlando, FL)
- ** Registered Nurse Case Manager** **AdventHealth** **Home Health** **All the benefits and perks you need for you and your family:** + Up to $5,000 Sign on Bonus ... Windermere area **The role you'll contribute:** The Home Health Registered Nurse (RN) Care Manager is a...needs. The RN Care Manager is responsible for independent management of the Home Health patient population requiring the… more
- AdventHealth (Winter Park, FL)
- …documents avoidable days, and facilitates progression of care. Collaborates with Utilization Management staff for collaboration on patient status changes ... valid State of Florida or multistate license as a Registered Nurse + 2 years of medical/...+ Health-related masters degree or MSN + Prior Care Management / Utilization Management experience +… more
- AdventHealth (Maitland, FL)
- …(8am-5pm or 9am-6pm)** **Location** : 600 Courtland Street, Maitland **The Care Transitions Registered Nurse ensures that a care plan is carried out in ... various other teams, including but not limited to Care Management nurses and social workers, nursing, home care liaisons,...State of Florida or multi state license as a Registered Nurse + Basic Life Support (BLS)… more
- AdventHealth (Davenport, FL)
- …experiences you'll need to succeed:** Associate's of Nursing 1 years of Work Experience Registered Nurse (RN) Basic Life Support - CPR Cert (BLS) This facility ... departments including surgery, dietician, rehabilitation and occupational therapy, nursing, case management , marketing, home health and others involved in the care… more
- Fresenius Medical Center (Winter Haven, FL)
- …staff training, equipment, physician and patient relations, cost containment, supply management , medical records, patient billing, OSHA and all company, state and ... quality of patient care, as defined by the quality goals, by working with management to ensure that policies and procedures are followed. + Assists with implementing… more
- Fresenius Medical Center (Haines City, FL)
- …Classification of Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review. + ... + Preferred but not required: + 3+ years supervisory or project/program management experience. + Med/surg or ICU/CCU experience. **PHYSICAL DEMANDS AND WORKING… more
- Molina Healthcare (Orlando, FL)
- …ensure appropriate reimbursement to providers. + Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) ... modification of payment decisions. + Serves as a clinical resource for utilization management , CMOs, physicians and member/provider inquiries/appeals. + Provides… more
- AdventHealth (Orlando, FL)
- …of experience in direct Care Management + State specific RN license if a nurse **Preferred qualifications:** + Registered Nurse : BSN + Social Worker: MSW ... expertise and experiences you'll need to succeed** **:** **Minimum qualifications** : + Registered Nurse : Associates Degree Nursing **_OR_** Social Worker: BSW +… more
- AdventHealth (Orlando, FL)
- …**The expertise and experiences you'll need to succeed** **:** **Minimum qualifications** : + Registered Nurse : BSN **_or_** Social Worker: MSW or BSW Masters in ... Specific RN license **_if a nurse_** **Preferred qualifications:** + Registered Nurse : MSN + Social Worker: MSW...above) in addition to 5 years of direct Care Management / Utilization Management experience and increasing… more
- HCA Healthcare (Kissimmee, FL)
- … Nurse + Associate Degree + Bachelor's in Nursing + 1+ year of prior case management experience + Registered Nurse - Currently licensed as a registered ... and admission status issues through established chain of command. + Performs utilization management reviews and communicates to third party payors. +… more
- Molina Healthcare (Orlando, FL)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active...emergency room. Previous experience in managed care Prior Auth, Utilization Review / Utilization Management … more
- Molina Healthcare (Orlando, FL)
- …internal meetings. **JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN). **Required Experience** 1-3 years of hospital ... Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual… more
- Molina Healthcare (Orlando, FL)
- …ensure payment integrity. * Performs clinical reviews of medical records and other utilization management documentation to evaluate issues of coding and DRG ... medical claims review, or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in the… more
- Molina Healthcare (Orlando, FL)
- …at least 3 or more years in one or more of the following areas: utilization management , care management , care transitions, behavioral health, or equivalent ... external vendors. + Focuses on process improvement, organizational change management , program management and other processes relative...combination of relevant education and experience. + Registered Nurse (RN), Licensed Vocational … more
- HCA Healthcare (Kissimmee, FL)
- …after relocation. + BLS-AHA Provider issued card required within 30 days of start + Registered Nurse Diploma + Associates Degree in Nursing or Diploma in Nursing ... stay, managing the length of stay, ensuring appropriate resource management and developing a safe appropriate discharge plan in...supporting a balance of optimal care and appropriate resource utilization . What you will do in this role: +… more
- Molina Healthcare (Orlando, FL)
- …and cost-effective member care. The candidate must have Medicare Appeals and/or Utilization Management knowledge. Work hours are Monday-Friday 8:00am- 5:00pm ... to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. **Required...or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active… more
- Molina Healthcare (Orlando, FL)
- For this position we are seeking a (RN) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity of ... to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required...or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active… more
- AdventHealth (Winter Park, FL)
- …REQUIRED** **:** Current, valid Florida State of Nursing license as a registered professional nurse + Basic Life Support (BLS) Provider Certification ... partnerships, research/ evidence-based practice/ quality/performance improvement, onboarding/orientation, and competency management . The NPD Manager functions as a learning facilitator,… more