- 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 (Sanford, 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 ... and 32714. **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 (Mount Dora, FL)
- …Umatilla, Altoona, Deland - Yellow Team **The role you'll contribute:** The Home Health Registered Nurse (RN) Care Manager is a professional nurse who ... on individual patient needs. The RN Care Manager is responsible for independent management of the Home Health patient population requiring the use of advanced… 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 (New Smyrna Beach, FL)
- …**Minimum qualifications** : + Associates degree Nursing or RN Diploma degree + Registered Nurse (RN) + Two (2) years of medical/hospital nursing experience. ... + BSN. + Health-related Master's degree or MSN. + Prior Care Management / Utilization Management experience. + ACM/CCM Certification This facility is an… more
- AdventHealth (Winter Garden, FL)
- …or RN Diploma degree + 2 years of medical/hospital nursing experience + Registered Nurse - State licensure and/or compact State licensure **Preferred ... + BSN or Health-related Master's degree or MSN + Prior Care Management / Utilization Management experience This facility is an equal opportunity employer… 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
- CenterWell (Deland, FL)
- …+ Graduate of an accredited School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR. + Valid driver's license, auto insurance ... clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates...and reliable transportation. + Two years as a Registered Nurse in a home care, with… 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
- AdventHealth (Altamonte Springs, FL)
- …and outcome measures in the delivery of patient care. b. Is active in utilization management , case management , quality improvement, and risk management ... **GENERAL SUMMARY** **:** The Chief Nursing Officer is a registered professional nurse with comprehensive responsibility for the assessment, problem… 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
- 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 (Altamonte Springs, FL)
- …Licensed Practical Nurse (LPN) - State Licensure **Preferred qualifications:** + Case Management + Registered Nurse State Licensure and/or Compact State ... care coordinator's primary responsibility is to oversee post-acute care utilization for identified populations. The Post-acute care coordinator will monitor… 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