Talent.com
Utilization Review Staff Job ID-1638446
Utilization Review Staff Job ID-1638446North Shore Medical Center • Miami, FL, USA
Utilization Review Staff Job ID-1638446

Utilization Review Staff Job ID-1638446

North Shore Medical Center • Miami, FL, USA
27 days ago
Job type
  • Full-time
  • Part-time
  • Quick Apply
Job description

We are North Shore Medical Center

Our primary function is to offer continuous nursing, medical, and other health and social services on a 24-hour basis, under physician-directed care and RN supervision.

We service a multitude of patients and their families across our vast network, while remaining committed to the professional development of our staff, the functional improvement of our patients, and the cultivation of strong partnerships within our communities.

WHAT WE OFFER

  • An essential / stable and growing company with many opportunities for training and advancement within the medical field that all employees and team members (including Full-Time and Part-Time) can benefit from.
  • Hourly pay is negotiable based on experience.
  • Comprehensive Employee Benefits : Full-Time employees are eligible for various plans for medical, dental, and vision insurance.

PRIMARY RESPONSIBILITIES

  • Conduct thorough reviews of clinical documentation to determine the medical necessity of services rendered.
  • Analyze data related to patient care and outcomes to identify areas for improvement.
  • Provide support in the development of clinical guidelines and protocols for utilization management.
  • Maintain up-to-date knowledge of medical terminology, coding (CPT, ICD-9, ICD-10), and healthcare regulations.
  • Engage in discharge planning and case management to facilitate patient transitions.
  • Skills

  • Conduct thorough reviews of clinical documentation to determine the medical necessity of services rendered.
  • Analyze data related to patient care and outcomes to identify areas for improvement.
  • Provide support in the development of clinical guidelines and protocols for utilization management.
  • Maintain up-to-date knowledge of medical terminology, coding (CPT, ICD-9, ICD-10), and healthcare regulations.
  • Engage in discharge planning and case management to facilitate patient transitions.
  • Education & Requirements

  • Experience in Utilization Management
  • Previous experience working in Acute Care, or Behavioral health
  • Ability to Communicate in English
  • BLS required
  • We are committed to creating :

    A safe and respectful work environment . We want our team members to enjoy the same sense of care and belonging that we provide for our patients.

    Teams that celebrate, empower, and uplift people. A supportive, inclusive culture, where people flourish and thrive is one that everyone embraces and deserves.

    A culture of inclusivity and kindness . Don't just treat people how you want to be treated : treat them how they want to be treated. We believe, "If you can be anything in this world, be kind".

    Must be able to pass Background and Drug Test screenings.

    Create a job alert for this search

    Utilization Review • Miami, FL, USA

    Related jobs
    Experienced Registered Nurse, Transplant Inpatient, Per Diem, Variable schedule

    Experienced Registered Nurse, Transplant Inpatient, Per Diem, Variable schedule

    Public Health Trust of Dade Co • Miami, FL, United States
    Full-time
    Department : Jackson Memorial Hospital - WW 15 - Transplant Inpatient.Shift details : Per Diem, Variable 7 : 00 am - 7 : 00 pm or 7 : 00 pm- 7 : 00 am (minimum three shifts a month).The PRM Clinical Staff Nu...Show more
    Last updated: 30+ days ago • Promoted
    Warehouse Operations Manager

    Warehouse Operations Manager

    Lavish Event Rentals Official • Miami, FL, US
    Full-time
    Lavish Event Rentals is a premier provider of luxury event furnishings, offering curated collections that elevate weddings, corporate events, and private celebrations. We combine high-end style with...Show more
    Last updated: 12 days ago • Promoted
    Level I CNA - Acute - $15-18 per hour

    Level I CNA - Acute - $15-18 per hour

    University of Miami • Miami, FL, United States
    Full-time
    University of Miami is seeking a CNA Acute Level I for a job in Miami, Florida.Job Description & Requirements.Certified Nursing Assistant, Surgical Intensive Care Unit (SICU).Days, Nights, Weekends...Show more
    Last updated: 30+ days ago • Promoted
    Sr. Manager - Outsourced Accounting Services (Special Projects)

    Sr. Manager - Outsourced Accounting Services (Special Projects)

    EisnerAmper • Miami, FL, United States
    Full-time
    At EisnerAmper, we look for individuals who welcome new ideas, encourage innovation, and are eager to make an impact.Whether you're starting out in your career or taking your next step as a seasone...Show more
    Last updated: 30+ days ago • Promoted
    Digital Warrior Experience Manager

    Digital Warrior Experience Manager

    Wounded Warrior Project • Miami, FL, United States
    Full-time
    We know these are some of the things people look for in a job.If you're the kind of person who believes that honoring and empowering our nation's veterans is more than just a cause - that it's a ca...Show more
    Last updated: 21 days ago • Promoted
    staff - Level II Registered Nurse (RN) - Infusion

    staff - Level II Registered Nurse (RN) - Infusion

    University of Miami • Coral Gables, FL, United States
    Full-time
    University of Miami is seeking a Registered Nurse (RN) Infusion Level II for a nursing job in Coral Gables, Florida.Job Description & Requirements. Assesses assigned patients and evaluates plans to ...Show more
    Last updated: 30+ days ago • Promoted
    Director of Compensation | UF Health System - Remote Opportunity

    Director of Compensation | UF Health System - Remote Opportunity

    UF Health • Miami, FL, US
    Remote
    Full-time
    Join Our Team at UF Health, Human Resources.UF Health Human Resources is seeking a thoughtful and experienced.This is a remote position, open to candidates living in Florida, and offers a unique op...Show more
    Last updated: 30+ days ago • Promoted
    CRNA (POOL / Staff Relief, Day shift)

    CRNA (POOL / Staff Relief, Day shift)

    Nicklaus Children's Health System • Miami, FL, United States
    Full-time
    Provides anesthetic care of the patients, exclusively under the direct supervision and guidance of a Pediatric Anesthesiologist. Obtains the patient’s medical history and performs physical exam.Veri...Show more
    Last updated: 4 days ago • Promoted
    Staff - Level II Registered Nurse (RN) - Infusion

    Staff - Level II Registered Nurse (RN) - Infusion

    University of Miami • Doral, FL, USA
    Full-time
    University of Miami is seeking a Registered Nurse (RN) Infusion Level II for a nursing job in Doral, Florida.Job Description & Requirements. The University of Miami Health System at Doral has an exc...Show more
    Last updated: 30+ days ago • Promoted
    RN - OR

    RN - OR

    HCA Kendall Regional Medical Center • Miami, FL, United States
    Full-time
    HCA Kendall Regional Medical Center.Operating room nurses provide direct and individualized nursing care to patients based on best-in-class operating procedures, nursing disciplines, and patient sa...Show more
    Last updated: 4 days ago • Promoted
    Level III CNA - Medical Unit - $15-18 per hour

    Level III CNA - Medical Unit - $15-18 per hour

    University of Miami • Miami, FL, United States
    Full-time
    University of Miami is seeking a CNA Medical Unit Level III for a job in Miami, Florida.Job Description & Requirements.Days, Nights, 1 Weekend Day is required. Work Location : University of Miami Hos...Show more
    Last updated: 30+ days ago • Promoted
    CRNA - Anesthesiology job available in Miami, Florida

    CRNA - Anesthesiology job available in Miami, Florida

    RecruitWell • Miami, FL, US
    Full-time
    Do you know someone that might be a good fit for this position? Please ask about our generous referral fees!.Monday-Friday, approximately 7a-4p. No anesthesiologist supervision.Allow RecruitWell to ...Show more
    Last updated: 30+ days ago • Promoted
    Staff - Level I Registered Nurse (RN) - Infusion

    Staff - Level I Registered Nurse (RN) - Infusion

    University of Miami • Miami, FL, USA
    Full-time
    University of Miami is seeking a Registered Nurse (RN) Infusion Level I for a nursing job in Miami, Florida.Job Description & Requirements. The Registered Nurse 1 - Specialty delivers patient-famil...Show more
    Last updated: 30+ days ago • Promoted
    Claims Examiner - Workers Compensation (REMOTE- Southeast State experience)

    Claims Examiner - Workers Compensation (REMOTE- Southeast State experience)

    Remote Staffing • Miami, FL, US
    Remote
    Full-time
    Claims Examiner - Workers Compensation.By joining Sedgwick, you'll be part of something truly meaningful.It's what our 33,000 colleagues do every day for people around the world who are facing the ...Show more
    Last updated: 2 hours ago • Promoted • New!
    RN - Trauma

    RN - Trauma

    HCA Florida Kendall Hospital • Miami, FL, United States
    Full-time
    We at Bestica believe our success is a direct result of hard work and outstanding employee dedication.Our environment is dynamic, friendly, and collaborative. We foster a positive culture, where inn...Show more
    Last updated: 4 days ago • Promoted
    Care Review Processor I

    Care Review Processor I

    Integrated Resources • Miami, FL, United States
    Full-time
    EST during training 9 : 00am - 6 : 00pm EST or 10 : 00am - 7 : 00pm after training.Works within the Care Access and Monitoring (CAM) team to provide clerical and data entry support for Client Members that ...Show more
    Last updated: 21 days ago • Promoted
    Hotel Accounting Admin - $16 - $18 / hr

    Hotel Accounting Admin - $16 - $18 / hr

    Courtyard by Marriott Miami / Coral Gables • Coral Gables, FL, United States
    Full-time
    Courtyard by Marriott Coral Gables is seeking an experienced Accounting Admin.Previous experience in an accounting role is required, preferably in the hospitality industry.Competitive pay rate is b...Show more
    Last updated: 20 days ago • Promoted
    Senior Performance Improvement Registered Nurse, Corp Quality & Accred Ops, FT, 8A-4 : 30P

    Senior Performance Improvement Registered Nurse, Corp Quality & Accred Ops, FT, 8A-4 : 30P

    Baptist Health South Florida • Coral Gables, FL, United States
    Full-time
    Baptist Health South Florida is the region's largest not-for-profit healthcare organization with 12 hospitals, more than 28,000 employees, 4,500 physicians, and 200 outpatient centers, urgent care ...Show more
    Last updated: 30+ days ago • Promoted