Utilization review nurse Jobs in Cape Coral, FL
Last updated: 2 days ago
Are you looking for a career opportunity that will help you grow personally and professionally?.Do you have a passion for helping others achieve Better Health?.
Are you ready to join a growing team ...Show moreLast updated: 30+ days ago
Jackson Nurse Professionals is seeking a travel nurse RN PCU - Progressive Care Unit for a travel nursing job in Fort Myers, Florida.
Job Description & Requirements Specialty : PCU - Progressive Care...Show moreLast updated: 3 days ago
Eye Centers of Florda, an affiliate of Eye Health America, is a growing, multi-specialty ophthalmology practice.Our focus is on excellence in patient care and creating an exceptional customer / patie...Show moreLast updated: 7 days ago
Responsible for the receiving and preparation of cases for the utilization review process.Often the first point of contact for providers, patients, and other healthcare professionals.Ensures all re...Show moreLast updated: 4 days ago
At Zelis, the Itemized Bill Review Facility Reviewer is responsible for analyzing facility inpatient and outpatient claims for Health Plans and ensuring adherence to proper billing guidelines.They ...Show moreLast updated: 30+ days ago
At CorroHealth our purpose is to help clients exceed their financial health goals.Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs.Enablin...Show moreLast updated: 30+ days ago
At Genworth, we empower families to navigate the aging journey with confidence.We are compassionate, experienced allies for those navigating care with guidance, products, and services that meet fam...Show moreLast updated: 30+ days ago
The circulating nurse is a registered nurse responsible for coordinating and managing the care of patients during surgical procedures.
They ensure the safety and comfort of the patient, maintain a s...Show moreLast updated: 30+ days ago
Nurse Navigator - • •Come join our Telehealth Rapid Response Center team and enjoy the new way of Nursing!! • •.This is an in person / in office position at our offices.
TeleSpecialists is a rapidly g...Show moreLast updated: 12 days ago
National well established AV rated full service law firm is seeking an General Liability Litigation Attorney to join their General Liability Litigation Defense department.The practice is focused in...Show moreLast updated: 6 days ago
Dial a Nurse is IMMEDIATELY hiring Nursing Assistants (CNAs) / Home Health Aides (HHA) to service patients in Ft Myers!.Must have Hoyer Lift experience!.
We offer WEEKLY PAY and Flexible Schedules.W...Show moreLast updated: 2 days ago
Humana”) offers competitive benefits that support whole-person well-being.Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while...Show moreLast updated: 30+ days ago
Bring your heart to CVS Health.Every one of us at CVS Health shares a single, clear purpose : Bringing our heart to every moment of your health.
This purpose guides our commitment to deliver enhanced...Show moreLast updated: 30+ days ago
Dane Street is expanding our physician panel! This is a telework opportunity for supplemental income for physicians providing a caseload customized to your schedule.
Our physician panel is comprised...Show moreLast updated: 30+ days ago
Registered Nurse Career Opportunity.Encompass Health : Where Nursing Meets Heart, Home, and Healing.Are you seeking a nursing career deeply rooted in purpose, close to your heart and home? Encompass...Show moreLast updated: 30+ days ago
This is a virtual position, but candidates must reside within 50 miles of an Elevance Health Pulse Point.Nurse Medical Management II - Utilization Management.
Ensures medically appropriate, high qua...Show moreLast updated: 30+ days ago
Medical Director Opportunity - Medicare Risk Adjustment HCC Review - Puerto Rico (Option to be Florida Based)!!.Option to either live in Puerto Rico or Florida.
Full-Time Opportunity, M-F 8am - 5pm ...Show moreLast updated: 30+ days ago
Sign On Bonus, Now Hiring for 3rd Shift!.Flexible Scheduling + Great Benefits = Oak Hill Senior Living.Registered Nurses join us at Oak Hill Senior Living to make a difference!.If you are an RN loo...Show moreLast updated: 2 days ago
Utilization Management Nurse
Better Health GroupRemote, FL$63,650.00–$80,000.00 yearly
Remote
Full-time
- Promoted
Travel Nurse RN - PCU - Progressive Care Unit - $1,801 per week
Jackson Nurse ProfessionalsFort Myers, FL, United States$1,801.00 weekly
Full-time
- Promoted
Registered Nurse
Clemson EyeFort Myers, FL, USFull-time
- Promoted
UTILIZATION REVIEW AND VALUE BASED COORDINATOR
Health Care District of Palm Beach CountyFL, United StatesFull-time
Itemized Bill Review Facility Reviewer
ZelisRemote, FL, USRemote
Full-time
Transfer DRG Revenue Review Specialist
CorroHealthFL, RemoteRemote
Full-time
Claims Clinical Specialist – Medical Review Team
Genworth FinancialFlorida$124,600.00 yearly
Remote
Full-time
- Promoted
Circulating Nurse
All Med SearchFort Myers, FL, USFull-time
- Promoted
Nurse Manager
TeleSpecialists LLCFort Myers, FL, USFull-time
- Promoted
General Liability Litigation Attorney (159)
Denovo ReviewFort Myers, FL, USFull-time
- Promoted
Love taking care of elderlies? If so, we need you! Must have Hoyer lift experience!
Dial-a-NurseFort Myers, FL, United StatesFull-time
Utilization Behavioral Health Professional
HumanaWork at Home, FloridaRemote
Full-time
Utilization Management Nurse Consultant
CVS HealthWork from home, FL, US$26.01–$56.13 hourly
Remote
Full-time
Board Certified Family Practice Physician for IME / Record Review -Cape Coral FL
Dane StreetCape Coral, Florida, United StatesFull-time
- Promoted
Registered Nurse
Encompass HealthCape Coral, FL, USFull-time
Nurse Medical Management II - Utilization Management
Elevance HealthFlorida$72,080.00–$129,744.00 yearly
Full-time
Medical Director Opportunity - Medicare Risk Adjustment HCC Review - Columbus, Ohio!!
Doctor’s Choice Placement ServicesSouth / Southeast, Florida, USFull-time +1
- Promoted
REGISTERED NURSE
Oak Hill Senior LivingFL, United StatesFull-time
Utilization Management Nurse
Better Health GroupRemote, FL30+ days ago
Salary
$63,650.00–$80,000.00 yearly
Job type
- Full-time
- Remote
Job descriptionAssess each request for medical services, considering factors such as medical necessity, appropriateness, and adherence to evidence-based clinical guidelines Utilize evidence-based clinical guidelines to make informed decisions regarding the approval or denial of requested medical services Collaborate with healthcare providers to gather input and seek their expertise in making utilization management decisions Communicate with healthcare providers, patients, and other stakeholders to gather necessary information, clarify any discrepancies, and provide updates on requested services Ensure compliance with regulatory requirements and internal policies to ensure all activities comply with regulatory requirements Monitor and track the utilization of medical services to identify trends, patterns, and opportunities for improvement and identify areas where cost-efficiency and quality of care can be optimized Collaborate with internal teams to develop and implement strategies for optimizing medical outcomes and cost-efficiency to meet organizations goals Provide education and support to healthcare providers regarding utilization management processes and guidelines Participate in quality improvement initiatives related to utilization management Contribute to the development, identify areas for improvement, and implement changes to enhance the overall quality of care Maintain accurate and up-to-date detailed records of all utilization management activities Additional duties as assigned Registered Nurse (RN) license in good standing within state of practice Bachelor's degree in Nursing or a related field, preferred 2 years of experience in Utilization Management Previous training and demonstrated competence in negotiations, Quality Assurance, and Case Management outcomes Demonstrated ability to solve complex, multifaceted, and emotionally charged situations Strong knowledge of evidence-based clinical guidelines and medical terminology Excellent critical thinking and decision-making skills Effective communication and interpersonal skills Ability to work independently and collaboratively in a fast-paced environment Proficiency in using computer systems and software for documentation and data analysis Proficient with Google Suite (Drive, Docs, Sheets, Slides) and Microsoft Office (Word, Excel, PowerPoint) for real-time collaboration Ability to remain in a stationary position, often standing or sitting for prolonged periods of time Communicating with others to exchange information Repeating motions that may include the wrist, hands, and / or fingers Assessing the accuracy, neatness, and thoroughness of work assigned Must be able to lift at least 15lbs at times Has a contagious and positive work ethic, inspires others, and models the behaviors of core values and guiding principles An effective team player who contributes valuable ideas and feedback and can be counted on to meet commitments Is able to work within our Better Health environment by facing tasks and challenges with energy and passion Pursues activities with focus and drive, defines work in terms of success, and can be counted on to complete goals Demonstrated ability to handle data with confidentiality Ability to work cross-functionally with multiple teams; ability to work independently with minimal supervision Excellent organizational, time-management, and multi-tasking skills with strong attention to detail Excellent written and verbal communication skills; must be comfortable communicating with providers and patients Strong interpersonal and presentation skills Strong critical thinking and problem-solving skills Must be results-oriented with a focus on quality execution and delivery Appreciation of cultural diversity and sensitivity toward target patient population Competitive base salary with bonus potential upon placement / retention Medical, dental, vision, disability and life 401k, with employer match Paid time off Paid holidays
Overview
Our mission is Better Health. Our passion is helping others.
What's Your Why?
- Are you looking for a career opportunity that will help you grow personally and professionally?
- Do you have a passion for helping others achieve Better Health?
- Are you ready to join a growing team that shares your mission?
Why Join Our Team : At Better Health Group, it's our commitment, our passion, and our culture that sets us apart. Our Team Members make a difference each and every day! They support our providers and payors, ensuring they have the necessary tools and resources to always deliver best-in-class healthcare experiences for our patients . We don't just talk the talk - we believe in it and live by it. Be part of a team that shares your passion and drive, and start living your purpose at Better Health Group.
Responsibilities
Position Objective :
The Utilization Management Nurse is responsible for managing requests providing a multi-faceted approach to managing requests for medical services while ensuring the services are medically appropriate and necessary. This role requires a multi-faceted approach, utilizing evidence-based clinical guidelines and input from healthcare providers. The incumbent will report to the Dir Utilization Mgmt (or similar role) and will work towards achieving high-quality, cost-efficient medical outcomes for patients requiring in-patient care and outpatient procedures.
Responsibilities :
Position Requirements / Skills :
Physical Requirements :
Key Attributes / Skills :
Compensation & Benefits :
We offer competitive compensation and comprehensive benefits package :
Pay Range
USD $63,650.00 - USD $80,000.00 / Yr.