Utilization review nurse Jobs in Palm Bay, FL
Last updated: 10 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
Palm Bay, Florida, with a flexible schedule that lets you prioritize your personal life.At IntelyCare, we value flexible schedules because we know that nursing professionals with work-life balance ...Show moreLast updated: 4 days ago
Bassin Plastic Surgery, a premier plastic surgery practice in Viera, Florida, is seeking an experienced.With a focus on delivering exceptional care in cosmetic procedures and rejuvenation, we are l...Show moreLast updated: 2 days ago
Join Our Passionate Team at Experience Senior Living!.Are you passionate about creating joy and enriching the lives of seniors while providing superior quality care? If so, then this is the opportu...Show moreLast updated: 10 hours 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
Nurse First is seeking a travel Interventional Radiology Technologist for a travel job in St.Job Description & RequirementsSpecialty : Interventional Radiology TechnologistDiscipline : Allied Health ...Show moreLast updated: 1 day ago
Called to serve patients in their home.The Registered Nurse approaches each day with a passionate pursuit of caring for patients by working one-on-one with them.
helping them regain their independe...Show moreLast updated: 14 hours ago
As an Pediatrics Registered Nurse, you will play a crucial role in providing high-quality healthcare to patients in various locations.
Your flexibility, adaptability, and expertise will be essential...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 hours ago
We help patients lead a more comfortable and productive life by keeping them engaged in their care and empowering them to manage their health and treatment at home.
Rotech provides high quality medi...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
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management / Health Services team.
Centene is a diversified, national organization offe...Show moreLast updated: 1 day ago
Compensation : Varies per assignment.Location : Remote (USA)Company : ProductReviewJobsThank you for your interest in becoming a Paid Product Tester.
This opportunity is for completing market research ...Show moreLast updated: 19 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
Utilization Management Nurse
Better Health GroupRemote, FL$63,650.00–$80,000.00 yearly
Remote
Full-time
- Promoted
Registered Nurse
IntelyCarePalm Bay, FL, United States$42.00–$57.00 hourly
Full-time
- Promoted
Dermatology Nurse Practitioner
DermCare ManagementMelbourne, FL, United States$60,000.00–$110,000.00 yearly
Part-time
- Promoted
- New!
WELLNESS NURSE (LPN)
Experience Senior LivingFL, 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
TRAVEL INTERVENTIONAL RADIOLOGY TECHNOLOGIST - $2,424 PER WEEK (HIRING IMMEDIATELY)
Nurse FirstFL, United States$2,424.00 weekly
Full-time
- Promoted
- New!
Registered Nurse
VitalCaringMelbourne, FL, United StatesFull-time
- Promoted
Pediatric Registered Nurse
Goldcrest Staffing Solution LLCMelbourne, FL, USFull-time
Care Review Clinician I
Saviance TechnologiesFlorida, US Works with the Utilization Management team primarily responsible for inpatient medical necessity / utilization review and other utilization management activities aimed at providing members with the r...Show moreLast updated: 30+ days ago
- Promoted
- New!
FORECLOSURE LITIGATION REAL ESTATE ATTORNEY (218B / O)
Denovo ReviewFL, United StatesFull-time
- Promoted
Respiratory Therapist / Nurse
Rotech Healthcare Inc.Melbourne, FL, USFull-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
- Promoted
Clinical Review Nurse - Prior Authorization
CenteneFL, United States$26.50–$47.59 hourly
Full-time
- Promoted
Paid Product Tester
Product Review JobsGRANT, FL, United States$500.00 weekly
Full-time
Medical Director Opportunity - Medicare Risk Adjustment HCC Review - Columbus, Ohio!!
Doctor’s Choice Placement ServicesSouth / Southeast, Florida, USPermanent
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.