Utilization review nurse Jobs in Coral Springs, FL
Last updated: 5 hours 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
Expanding full-service real estate law firm based in South Florida is seeking a Foreclosure Litigation Real Estate Attorney to join their team.
The successful candidate will be responsible for worki...Show moreLast updated: 10 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: 9 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 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 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
With Wanderly you can chat and apply to any agency with Wanderly’s Universal Application, below are the details of this.Specialty : Case Manager - RN RN.
Travel Case Manager (CM ) Registered Nurse : ...Show moreLast updated: 5 hours ago
Utilization Review Clinical Manager – Exact Billing Solutions.Exact Billing Solutions is a unique team of medical billing professionals specializing in the substance use disorder, mental health, an...Show moreLast updated: 6 hours ago
Medical Solutions is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Margate, Florida.
Job Description & Requirements.We’re seeking talented healthcare profess...Show moreLast updated: 1 day ago
Medical Solutions is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Margate, Florida.
Job Description & Requirements.We’re seeking talented healthca...Show moreLast updated: 22 hours ago
The Manager of Utilization Management (UM) is a Registered Nurse (RN) who is responsible for all aspects of compliance related to utilization management and prior authorization across the continuum...Show moreLast updated: 18 hours ago
Nurse First is seeking a travel nurse RN Utilization Review for a travel nursing job in Margate, Florida.Job Description & Requirements.
Pay package is based on 8 hour shifts and 40 hours per week (...Show moreLast updated: 15 hours 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
Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, inc...Show moreLast updated: 1 day ago
Utilization Management Nurse
Better Health GroupRemote, FL$63,650.00–$80,000.00 yearly
Remote
Full-time
- Promoted
Foreclosure Litigation Real Estate Attorney (218b / o)
Denovo ReviewBoca Raton, FL, USFull-time
- Promoted
UTILIZATION REVIEW AND VALUE BASED COORDINATOR
Health Care District of Palm Beach CountyFL, United StatesFull-time
Transfer DRG Revenue Review Specialist
CorroHealthFL, RemoteRemote
Full-time
Itemized Bill Review Facility Reviewer
ZelisRemote, FL, USRemote
Full-time
Claims Clinical Specialist – Medical Review Team
Genworth FinancialFlorida$124,600.00 yearly
Remote
Full-time
- Promoted
- New!
Case Manager (CM ) RN
Jackson Nurse ProfessionalsMargate, FL, United States$1,886.00 weekly
Full-time
- Promoted
- New!
Utilization Review Clinical Manager
Exact Billing SolutionsLauderdale Lakes, FL, USFull-time
- Promoted
Travel Nurse RN - Case Manager, Utilization Review - $1,957 per week
HealthEcareers - ClientMargate, FL$1,957.00 weekly
Full-time
- Promoted
- New!
Travel Nurse RN - Case Manager, Utilization Review - $1,970 per week
Medical SolutionsMargate, FL, US$1,970.00 weekly
Full-time
- Promoted
- New!
Manager, Utilization Management
Community Care Plansunrise, FL, United StatesFull-time
- Promoted
- New!
Travel Nurse RN - Utilization Review - $2,268 per week
Nurse FirstMargate, FL, United States$2,268.00 weekly
Full-time
DIR - UTILIZATION REVIEW / MGMT
Foundations for LivingOAKLAND PARK, Florida, United States Fort Lauderdale Behavioral Health Center.Oakland Park, neighborhood of Fort Lauderdale, FL.Fort Lauderdale Behavioral features individual units for children, adolescents, adults, and seniors, and o...Show moreLast updated: 30+ days ago
Utilization Review Registered Nurse, Case Management, FT, 8A-4 : 30P
Boca Raton Regional HospitalBoca Raton Baptist Health South Florida is the region’s largest not-for-profit healthcare organization with 12 hospitals, more than 27,000 employees, 4,000 physicians, and 200 outpatient centers, urgent care ...Show moreLast updated: 30+ days ago
Nurse Medical Management II - Utilization Management
Elevance HealthFlorida$72,080.00–$129,744.00 yearly
Full-time
Care Review Clinician, PA (RN)
Molina HealthcareBoca Raton, FL, United States$26.41–$61.79 hourly
Full-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.