- Humana (Tallahassee, FL)
- …and help us put health first** Humana Healthy Horizons in Ohio is seeking a Utilization Management Nurse 2 who utilizes clinical nursing skills to support ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- CVS Health (Tallahassee, FL)
- …skills, both verbal and written Required Qualifications - 3+ years of experience as a Registered Nurse - Must possess 1+ years of clinical experience in acute or ... and external constituents in the coordination and administration of the utilization /benefit management function. + Typical office working environment with… more
- CVS Health (Tallahassee, FL)
- …both verbal and written Required Qualifications - 3+ years of experience as a Registered Nurse - Must have active current and unrestricted RN licensure in ... and external constituents in the coordination and administration of the utilization /benefit management function. + Typical office working environment with… more
- Humana (Tallahassee, FL)
- **Become a part of our caring community and help us put health first** The Compliance Utilization Management Nurse 2 reviews utilization management ... rotating schedule. (about 2 holidays per year) The Compliance Utilization Management Nurse 2 ensures...make an impact** **Required Qualifications** + Active unrestricted Licensed Registered Nurse , (RN), in your state of… 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 ... documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are… more
- Humana (Tallahassee, FL)
- …projects. **Use your skills to make an impact** **Required Qualifications** + Licensed as a Registered Nurse in the State of Wisconsin or have a compact license. ... inpatient and subacute activity daily for outcomes related to readmission, utilization , quality of care and provider performance in compliance with Humana/iCare… more
- Marriott (Tallahassee, FL)
- …Information** Nurse CARE Manager (CARE - Coordinated Action and Response) Registered Nurse license required **Job Number** 24069165 **Job Category** Finance ... Claims Services + Collaborate with Claims department regarding case management . + Collaborate with UNM on utilization ...informed **Education or Certification** + Must be a licensed registered nurse + Certification as an occupational… more
- Centene Corporation (Tallahassee, FL)
- …Certified (CMAC):** **Case Management Certified (CMC):** **Certified Case Manager (CCM):** Registered Nurse Case Manager (RN-CM) Registered Nurse ... policies, procedures and processes. + Facilitate on-going communication between case management staff, utilization management staff and contracted… more
- HCA Healthcare (Tallahassee, FL)
- …10+ years overall case management experience required + Currently licensed as a Registered Nurse in the state(s) of practice according to law and regulation ... to HCA established policies, practices, efficiencies; and effectiveness of clinical Case Management , Utilization Management , and Social Work functions within… more
- Evolent Health (Tallahassee, FL)
- …Be Doing:** As an Initial Clinical Reviewer, you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... reviewers are supported by Physician clinical review staff (MDs) in the utilization management determination process. + Reviews charts and analyzes clinical… more
- CenterWell (Tallahassee, FL)
- …license, auto insurance and reliable transportation. + Two years as a Registered Nurse with at least one-year of management experience in a home care, ... clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates...School of Nursing. + Current state license as a Registered Nurse . + Proof of current CPR.… more
- Centene Corporation (Tallahassee, FL)
- …is required OR an RN with a behavioral health background:** Required Licensed Registered Nurse (RN) Required Licensed Clinical Social Worker (LCSW) Required ... management and/or acute behavioral health care setting focusing on outpatient/inpatient utilization , case management and discharge planning Required 1+ year… more
- Highmark Health (Tallahassee, FL)
- …member is responsible for building relationships, engaging clinicians, educating on Utilization Management policies and processes, developing workflows and ... in provider setting. + 3 years of experience in utilization management /care management /QA/managed care ...diploma. **Preferred** + None **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse (RN) license in PA; additional… more