NewTravel Nurse RN - Utilization Review - $2,301 per week LanceSoftTravel Nurse RN - Utilization Review - $2,301 per weekFort Myers, FLLanceSoft specializes in providing Registered Nurses, Nurse Practitioners, LPNs/LVNs, Social Workers, Medical Assistants, and Certified Nursing Assistants to work in Acute Care Centers, Skilled Nursing Facilities, Long-Term Care centers, Rehab Facilities, Behavioral Health Centers, Drug & Alcohol Facilities, Home Health & Community Health, Urgent Care Clinics, and many other provider-based facilities. Our team of experienced career specialists takes the time to understand your needs and match you with the right job Lancesoft has been chosen by Staffing Industry Analysts as one of the Best Staffing Firms to Work for.
NewTravel Nurse RN - Utilization Review - $1,829 to $1,924 per week in Largo, FL TravelNurseSourceTravel Nurse RN - Utilization Review - $1,829 to $1,924 per week in Largo, FLLargo, FL$1,829–$1,924As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
NewTravel Nurse RN - Utilization Review - $1,923 to $2,018 per week in Fort Myers, FL TravelNurseSourceTravel Nurse RN - Utilization Review - $1,923 to $2,018 per week in Fort Myers, FLFort Myers, FL$1,923–$2,018As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership. *Estimated weekly pay includes projected hourly wages and weekly meal and lodging per diems for eligible clinicians based on nationally published GSA rates.
NewTravel Nurse RN - Utilization Review - $1,740 per week in Brooksville, FL TravelNurseSourceTravel Nurse RN - Utilization Review - $1,740 per week in Brooksville, FLBrooksville, FL$1,740Benefits: Day 1 Insurance Cigna medical, MetLife dental and vision insurance License reimbursement for new licenses needed for each assignment Discounts with hotels and rental cars A dedicated recruiter and support team that will help you every step of the way to sure you start on time and have an exceptional experience Referral bonus up to $700 About the Company: As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership.
NewTravel Nurse RN - Utilization Review - $1,693 per week in Fort Walton Beach, FL TravelNurseSourceTravel Nurse RN - Utilization Review - $1,693 per week in Fort Walton Beach, FLFort Walton Beach, FL$1,693Benefits: Day 1 Insurance Cigna medical, MetLife dental and vision insurance License reimbursement for new licenses needed for each assignment Discounts with hotels and rental cars A dedicated recruiter and support team that will help you every step of the way to sure you start on time and have an exceptional experience Referral bonus up to $700 About the Company: As an award-winning talent partner, we support healthcare professionals through every step of that process, offering meaningful opportunities, clear guidance, and long-term partnership.
NewTravel RN Case Management - $2,094 per week MedPro Healthcare StaffingTravel RN Case Management - $2,094 per weekLargo, FLWork is administered in a variety of settings, including HMOs, community health organizations, long-term care facilities, behavioral health programs, rehabilitation centers, schools, and case management companies. MedPro Healthcare Staffing , a Joint Commission-certified staffing agency, is seeking a quality Case Manager Registered Nurse (RN) for a travel assignment with one of our top healthcare clients.
NewRegistered Nurse (RN) - Case Management - $30-41 per hour Lee HealthRegistered Nurse (RN) - Case Management - $30-41 per hourFort Myers, FL$30.27–$40.86 / hourThe Case Manager has clinical expertise with knowledge of medically appropriate criteria, and applies principles of utilization and quality management, discharge planning and the management of clinical/financial resources as a facilitator and active participant of the multidisciplinary patient care team. The Case Manager predicts, facilitates and evaluates the transition of patients across the care continuum and links people to systems that provide them with resources, services and opportunities to achieve and maintain maximum functioning.
NewRN Coordinator | Adult Emergency Department | Full-Time | Nights UF HealthRN Coordinator | Adult Emergency Department | Full-Time | NightsGainesville, FL$78,811.20–$135,512Licensure/Certification/Registration: Current RN license in state of Florida Motor Vehicle Operator Designation: Employees in this position: Will not operate vehicles for an assigned business purpose NOTE: A frequent driver is defined as one who uses his/her personal or University of Florida Health automobile a) at least once daily, b) at least five individual trips per week or c) drives, on average, over 150 miles per week in the performance of his/her job. Assists with clinical coverage schedules, and serves as a clinical expert for patient care and services in the unit by providing clinical leadership support and direct patient care if staffing requires.
NewNurse Practitioner - Family Practice - $105K-150K per year ChenMedNurse Practitioner - Family Practice - $105K-150K per yearJacksonville, FL$111,140–$158,771 / yearThe Nurse Practitioner (NP) acts as part of the clinical operations team and is responsible for providing direct patient care in ChenMed/Jencare medical centers, nursing homes, skilled nursing facilities (SNF) and home settings depending on the nature of the assignment or providing assessments to members in SNF and home settings. Plans patient care based on in-depth knowledge of the specific patient population and/ or protocol, anticipating and identifying physiological and/ or psychological problems commonly encountered including the consideration of the patient’s cultural background, level of understanding, personality and support systems.
NewTravel Emergency Department RN - $2,189 per week Prime StaffingTravel Emergency Department RN - $2,189 per weekPensacola, FLLicensing/Certification Current RN License in the state in which they are working or covered by compact (required) BLS Basic Life Support or ACLS Advanced Cardiac Life Support and PALS Pediatric Advanced Life Support (preferred at hire, must obtain from approved source prior to direct patient care; ACLS and PALS required within 6 months of hire) NPR Neonatal Resuscitation Program (preferred) TNCC Trauma Nursing Core Course (preferred) Education Bachelor of Science Nursing (preferred) Work Experience 1 year of RN experience (required) Recent Emergency Department or Critical Care experience (preferred) Training EPIC Electronic Health Record (EHR) training (preferred) Skills Assigns patient care according to the nursing skill, knowledge, and scope of practice of staff. 34-66% Additional Physical Requirements/Hazards Manual dexterity (eye/hand coordination) Perform shift work Maneuver weight of patients Hear alarms/telephone/audio recorder Reach above shoulder Repetitive arm/hand movements Finger Dexterity Color Vision Acuity - far Acuity - near Depth perception Use of latex products Exposure to toxic/caustic/chemicals/detergents Exposure to moving mechanical parts Exposure to dust/fumes Exposure to potential electrical shock Exposure to x ray/electromagnetic energy Exposure to high pitched noises Gaseous risk exposure Patient Population Demonstrates the knowledge and skills necessary to provide care appropriate to the age of the patients served on his or her assigned unit.
NewTravel Nurse RN - Manager - $3,420 per week Healthcare SupportTravel Nurse RN - Manager - $3,420 per weekMiami, FLYour travel team will include a designated credentialing expert to help you navigate every step of the on-boarding process, a payroll specialist who you can communicate with directly, and a skilled recruiter who takes the time to understand your needs and works hard to find the right position for you. Not only does HealthCare Support reimburse for relocation and travel costs on your first check, but we also offer license and certification reimbursements required for your assignments so that you can focus on building your career.
Dialysis Clinical Manager Registered Nurse - RN Fresenius Medical CareDialysis Clinical Manager Registered Nurse - RNJacksonville, FLOther: • Collaborates closely with, providing oversight as needed to, the Clinical Manager/Charge RN acting as nurse manager, the Medical Director, and the physicians regarding the direct patient care responsibilities within the facility to ensure the provision of outstanding quality of patient care, as defined by the FMS quality goals, and compliance with the pertinent company policies and procedures. • Demonstrated leadership competencies and management skills for the position, including excellent communication, customer service, continuous quality improvement, relationship development, results orientation, team building, motivating employees, performance management and decision making.
NewCase Management Director Encompass Health Rehabilitation Hospital of ClermontCase Management DirectorWinter Garden, FLJoin us in this journey of care, compassion, and leadership as we work together to make a difference where it matters most, serving as a key member of our leadership team overseeing the day-to-day operations and management of our Case Management department. Oversee the interdisciplinary plan of care and the discharge planning process to ensure the effectiveness and appropriateness of services with a central focus on census management, patient care outcomes, and key care indicators.
Nurse Manager ICU Trauma Neuro HCA Florida Osceola HospitalNurse Manager ICU Trauma NeuroKissimmee, FLAdditional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more. Other services include The Baby Suites Maternity Care, Neonatal Intensive Care Unit Level II, Women’s Services, Behavioral Health, Orthopedics & Spine, and a Graduate Medical Education Program.
Laboratory Director HCA Florida Fort Walton-Destin HospitalLaboratory DirectorFort Walton Beach, FLOur infrastructure includes a fully automated esoteric core laboratory in Fort Lauderdale, a histology and microbiology operation in Largo, Florida, and a network of hospital-based rapid-response laboratories present in four HCA Healthcare divisions in Florida. HCA Healthcare Laboratory Services is a full-service provider of clinical laboratory and anatomic pathology services, providing hospitals, physicians, and clients with timely diagnostic information for patient care.
NewTravel Nurse RN - Case Manager - $43 per hour in Tallahassee, FL TravelNurseSourceTravel Nurse RN - Case Manager - $43 per hour in Tallahassee, FLTallahassee, FL$43TravelNurseSource is working with Medical Edge Recruitment to find a qualified Case Manager RN in Tallahassee, Florida, 32308! Requirements: Current and valid Florida (or compact state) RN (Registered Nurse) license required.
NewTravel Nurse RN - Case Manager - $1,620 to $1,800 per week in St. Petersburg-Clearwater, FL TravelNurseSourceTravel Nurse RN - Case Manager - $1,620 to $1,800 per week in St. Petersburg-Clearwater, FLSt. Petersburg-Clearwater, FL$1,620–$1,800Works in collaborative practice with Physicians and Physician extenders to actively support the delivery of cost effective, outcome oriented, quality care in the appropriate health care setting to meet patient specific, age and cultural needs. Works in collaborative practice with the physician and other members of the health care team to meet patient specific and age-related needs linking cost and quality to patient care.
NewTravel Nurse RN - Case Manager - $1,573 to $1,747 per week in Western Panhandle, FL TravelNurseSourceTravel Nurse RN - Case Manager - $1,573 to $1,747 per week in Western Panhandle, FLWestern Panhandle, FL$1,573–$1,747Works in collaborative practice with Physicians and Physician extenders to actively support the delivery of cost effective, outcome oriented, quality care in the appropriate health care setting to meet patient specific, age and cultural needs. Works in collaborative practice with the physician and other members of the health care team to meet patient specific and age-related needs linking cost and quality to patient care.
NewAssociate Medical Device Sales Representative Medical Sales CollegeAssociate Medical Device Sales RepresentativeBradenton, FLMuch like the specialized technical certifications and self-funded training tracks required to enter fields like veterinary technology or nursing, this program requires a personal tuition investment from the candidate (with financing options and flexible payment plans available for qualified applicants). Pathway Requirement: Successful completion of the required Medical Sales College program (such as TotalOrtho, TotalOrtho+, or specialized diagnostic/orthopedic tracks) serves as the prerequisite industry baseline for candidates lacking direct field experience.
Hospital Laboratory Director HCA Florida Sarasota Doctors HospitalHospital Laboratory DirectorSarasota, FLHuman Resource Functions: Monitors and evaluates the activities of the staff and provides management, coaching, guidance, delegation opportunities, and on-the-job training and re-training as necessary to ensure operational efficiency and adherence to policies and procedures; fosters open communication by offering, encouraging, and accepting suggestions from staff regarding department operations. Our infrastructure includes a fully automated esoteric core laboratory in Fort Lauderdale, a histology and microbiology operation in Largo, Florida, and a network of hospital-based rapid-response laboratories present in four HCA Healthcare divisions in Florida.
Director of Nursing Gulf Coast Village Skilled NursingDirector of NursingCape Coral, FLVerbal and written abilities necessary to communicate and work effectively with various levels of staff, residents, family members and the public, and representatives of the various regulatory agencies, and for required written documentation or reports. Numerical ability necessary to make various computations in planning departmental objectives, keeping work records and schedules, preparing budgets, requisitioning supplies, and monitoring inventory control.
RN, Utilization Management | Utilization Management UF HealthRN, Utilization Management | Utilization ManagementThe Villages, FloridaFull timeEvaluates patient medical records to determine the medical necessity and appropriateness of healthcare services in alignment with utilization management guidelines. Collaborates with healthcare providers to support compliance, optimize treatment plans, and promote efficient resource utilization.
RN, Utilization Management | Utilization Management| Day| Full Time UF HealthRN, Utilization Management | Utilization Management| Day| Full TimeSt. Johns, FloridaFull time3+ years experience in utilization review or case management • Knowledge of healthcare utilization guidelines and compliance • Experience evaluating medical necessity and treatment plans • Strong communication skills for authorization decisions • Ability to analyze utilization data and support care coordination Licensure/Certification/Registration: Involves coordinating with healthcare providers to maintain compliance with utilization management guidelines and optimizing treatment plans for effective patient care and resource utilization.
RN, Utilization Management | Utilization Management| Variable | PRN UF HealthRN, Utilization Management | Utilization Management| Variable | PRNLeesburg, FloridaPer diemInvolves coordinating with healthcare providers to maintain compliance with utilization management guidelines and optimizing treatment plans for effective patient care and resource utilization. Analyzes utilization data to identify trends and collaborates with interdisciplinary teams to enhance care coordination while ensuring accurate documentation and regulatory compliance.
RN, Utilization Management | Utilization Management| Night | Part Time UF HealthRN, Utilization Management | Utilization Management| Night | Part TimeGainesville, FloridaPart timeInvolves coordinating with healthcare providers to maintain compliance with utilization management guidelines and optimizing treatment plans for effective patient care and resource utilization. Analyzes utilization data to identify trends and collaborates with interdisciplinary teams to enhance care coordination while ensuring accurate documentation and regulatory compliance.
RN, Utilization Management Lead | Utilization Management| Day Full Time UF HealthRN, Utilization Management Lead | Utilization Management| Day Full TimeGainesville, FloridaFull timeRN Utilization Lead under the general supervision of the Director, is responsible for department coordination of utilization, other review activities to ensure payment for services is authorized and an active and effective utilization management program is maintained. Re gistered nurse (RN) with current Florida license with a minimum of two (2) years experience performing utilization review in a hospital setting, for a third party payer or other review agency or organization.
RN, Utilization Management | Utilization Management University of Florida Health Science CenterRN, Utilization Management | Utilization ManagementThe Villages, FLEvaluates patient medical records to determine the medical necessity and appropriateness of healthcare services in alignment with utilization management guidelines. Collaborates with healthcare providers to support compliance, optimize treatment plans, and promote efficient resource utilization.
RN, Utilization Management | Utilization Management| Day| Full Time University of Florida Health Science CenterRN, Utilization Management | Utilization Management| Day| Full TimeSt. Johns, FLInvolves coordinating with healthcare providers to maintain compliance with utilization management guidelines and optimizing treatment plans for effective patient care and resource utilization. Analyzes utilization data to identify trends and collaborates with interdisciplinary teams to enhance care coordination while ensuring accurate documentation and regulatory compliance.
RN, Utilization Management | Utilization Management| Variable | PRN University of Florida Health Science CenterRN, Utilization Management | Utilization Management| Variable | PRNLeesburg, FLInvolves coordinating with healthcare providers to maintain compliance with utilization management guidelines and optimizing treatment plans for effective patient care and resource utilization. Analyzes utilization data to identify trends and collaborates with interdisciplinary teams to enhance care coordination while ensuring accurate documentation and regulatory compliance.
RN, Utilization Management | Utilization Management| Night | Part Time University of Florida Health Science CenterRN, Utilization Management | Utilization Management| Night | Part TimeGainesville, FLInvolves coordinating with healthcare providers to maintain compliance with utilization management guidelines and optimizing treatment plans for effective patient care and resource utilization. Analyzes utilization data to identify trends and collaborates with interdisciplinary teams to enhance care coordination while ensuring accurate documentation and regulatory compliance.
NewUtilization Management Nurse Consultant CVS Health CorpUtilization Management Nurse ConsultantFL$26.01–$62.32 / hourOur teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do.
RN, Utilization Management Lead | Utilization Management| Day Full Time University of Florida Health Science CenterRN, Utilization Management Lead | Utilization Management| Day Full TimeGainesville, FLRN Utilization Lead under the general supervision of the Director, is responsible for department coordination of utilization, other review activities to ensure payment for services is authorized and an active and effective utilization management program is maintained. Minimum Education and Experience Requirements: Registered nurse (RN) with current Florida license with a minimum of two (2) years experience performing utilization review in a hospital setting, for a third party payer or other review agency or organization.
Pool Utilization Review Registered Nurse, Case Management, Per Diem, Shift Varies (Rotating Weekends) Baptist Health South Florida IncPool Utilization Review Registered Nurse, Case Management, Per Diem, Shift Varies (Rotating Weekends)Boca Raton, FLSpecific functions within this role include: Screens pre-admission, admission process using established criteria for all points of entry, Facilitates communication between payers, review agencies and healthcare team, Identify delays in treatment or inappropriate utilization and serves as a resource, Coordinates communication with physicians, Identify opportunities for expedited appeals and collaborates resolve payer issues and ensures, maintains effective communication with Revenue Cycle Departments. Baptist Health is the region''s largest not-for-profit healthcare organization, with 12 hospitals, over 29,000 employees, 4,500 physicians and 200 outpatient centers, urgent care facilities and physician practices across Miami-Dade, Monroe, Broward and Palm Beach counties.
Utilization Management RN AdventHealthUtilization Management RNDaytona Beach, FL$68,132.50–$119,520.35 / yearAccesses and reviews payer portals for authorization numbers in collaboration with department assistants; ensures proper update of authorization fields within EMR accordingly, delegating appropriate tasks to support staff. Applicants may review general information about Florida's background screening requirements at the Florida Care Provider Background Screening Clearinghouse: https://info.flclearinghouse.com/ .
ED Utilization Management RN AdventHealthED Utilization Management RNOrmond Beach, FL$32.76–$57.47 / hourRequired] • Ability to work with little supervision [Required] • Self-motivated [Required] • Microsoft office suite of applications experience [Required] • Excellent time management skills to effectively navigate in fast-paced work environment with time constraints in place [Required] • Ability to interact effectively with providers and other health care professionals [Required] • Strong clinical skills to evaluate severity of disease state [Required] • Discharge planning knowledge [Required] **Education:** • Associate's of Nursing [Required] • Bachelor's of Nursing [Preferred] **Field of Study:** • N/A **Work Experience:** • 1+ Utilization Management or Care Management experience [Preferred] • 3+ acute care and/or emergency department experience [Required] • 3+ years related experience [Required] **Additional Information:** • N/A **Licenses and Certifications:** • Registered Nurse (RN) [Required] • Certified Case Manager (CCM) [Preferred] • Accredited Case Manager (ACM) [Preferred] **Physical Requirements:** _(Please click the link below to view work requirements)_ Physical Requirements - https://tinyurl.com/msy4mja2 **Pay Range:** $32.76 - $57.47 **Background Screening Requirement (Florida Law)** Certain positions are subject to **Florida Level 2 background screening** , including fingerprinting, as required by state law. **Knowledge, Skills, and Abilities:** • Knowledge and understanding of utilization management criteria [Required] • Excellent analysis, problem- solving and critical thinking skills.
Registered Nurse Utilization Review, Case Management, Part Time, 7P-7:30A Baptist Health South Florida IncRegistered Nurse Utilization Review, Case Management, Part Time, 7P-7:30ASouth Miami, FL$73,860.80–$98,234.86 / yearOur approach is rooted in a "grow our own" philosophy, designed to help our team members build meaningful, long-term careers with us, supported by benefits that make a real difference, including: Career growth and development opportunities, with clear pathways and ongoing support. Baptist Health is the region''s largest not-for-profit healthcare organization, with 12 hospitals, over 29,000 employees, 4,500 physicians and 200 outpatient centers, urgent care facilities and physician practices across Miami-Dade, Monroe, Broward and Palm Beach counties.
HEDIS Utilization Review Nurse Central Florida Health CareHEDIS Utilization Review NurseWinter Haven, FloridaWork closely with PCP to manage patient “care items” which could include; medication refills per protocol, lab triage, document management, management of durable medical equipment (i.e. Glucometer, test strips, lancets), prior authorizations of needed medications or other services. Primary Duties include, but are not limited to, the following: Assess, identify problems, plan goals, monitor and evaluate patient plans, and develop strategies that meet the patients immediate and long-term goals.
Utilization Review Nurse Health Business Solutions LLCUtilization Review NurseCooper City, FLThe Utilization Review Nurse will play a crucial role in supporting our clients in the healthcare industry by providing expert clinical guidance, facilitating effective utilization management, and ensuring revenue cycle efficiency. Care Coordination : Collaborate with interdisciplinary healthcare teams to coordinate patient care and treatment plans, ensuring the most cost-effective and clinically appropriate care is provided.
Utilization Review Nurse Miami Jewish Health Systems IncUtilization Review NurseMiami, FLThis role collaborates closely with hospital UR/Case Management, facility and community providers, and the Interdisciplinary Team (IDT) to facilitate timely care transitions, prevent avoidable days, and ensure members receive only medically necessary services in accordance with evidence-based criteria, payer policies, and regulatory requirements. We operate Florida PACE (Program of All-Inclusive Care for the Elderly) Centers, the largest PACE program in Florida, which serves as health plan, healthcare provider, and social center designed for older adults with complex medical needs.
NewUtilization Review Nurse Oscar HealthUtilization Review NurseMiami, FLRemote$35–$45.94 / hourWork Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois; Iowa; Kansas; Michigan; Missouri; Nebraska; New Jersey; North Carolina; Ohio; Oklahoma; Pennsylvania; South Carolina; Tennessee; Texas; or Virginia. Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC).
NewUtilization Management Professional Integrated Resources, IncUtilization Management ProfessionalMiami, FloridaContractorJob DescriptionTitle: Utilization Management ProfessionalLocation: Miami FL 33126Duration: 6 months (Contract to Hire)Responsibilities:· Under general supervision by management, and in collaboration with Medical Directors and other members of the clinical team, gathers and synthesizes clinical information in order to authorize services.· Reviews health care services to determine consistency with contract requirements, coverage policies and evidence-based medical necessity criteria; collects and analysis utilization information; assists with program processes for transitions across levels of care including discharge planning and ambulatory follow up activity.· Selected candidate will have at least 3-5 years of experience in a Psychiatric Inpatient Setting or 3-5 years of Health Plan or 3-5 years of Managed Behavioural Health experience Utilization Reviews experience.· Correctional facility experience WILL NOT be viewed as inpatient experience.·
Utilization Management Reviewer Mental Health Resource CenterUtilization Management ReviewerJacksonville, FloridaOutpatient services include medication management, care coordination, case management, intensive case management team services, counseling, psychosocial rehabilitation, an adult therapeutic family program, state hospital liaison services, mental health court, multidisciplinary forensic teams (MFT), jail-based diversion services, a Co-Responder Program with the Jacksonville Sheriff’s Office, the Link-to-Life suicide prevention program, and services that assist individuals in obtaining benefits such as Social Security Income, Social Security Disability Income, Medicaid, food stamps, and housing. MHRC also operates eight Florida Assertive Community Treatment (FACT) programs for adults with severe and persistent mental illness, located in Clearwater, Gainesville, Jacksonville, Kissimmee, Rockledge, Tampa, and Winter Haven, as well as a FACT Lite program providing Linking, Advocating, Treating, Transitioning, Empowering & Recovery Support (LATTERS) services in Jacksonville.
NewUtilization Management Specialist Integrated Resources, IncUtilization Management SpecialistMiami, FloridaContractorReviews health care services to determine consistency with contract requirements, coverage policies and evidence-based medical necessity criteria; collects and analyzes utilization information; assists with program processes for transitions across levels of care including discharge planning and ambulatory follow up activity. Utilization Management SpecialistUnder general supervision by management, and in collaboration with Medical Directors and other members of the clinical team, gathers and synthesizes clinical information in order to authorize services.
Senior Director of Utilization Management TurningPoint Healthcare SolutionsSenior Director of Utilization ManagementLake Mary, FloridaThe Senior Director serves as a key member of the Operations leadership team and partners closely with Clinical Operations, Quality, Technology, Product, Client Services, Implementation, Medical Policy/Coding and Growth teams to achieve organizational objectives and client commitments. Preferred Skills: Preferred skills include executive communication, client partnership, operational problem solving, process improvement, people leadership, change management, performance analytics, regulatory awareness, and the ability to lead through influence in a matrixed environment.
APRN - Utilization Management/Physician Advisor Services BayCare Health SystemAPRN - Utilization Management/Physician Advisor ServicesTampa, FLAssists Physician Advisors to develop and implement methods to optimize use of hospital services for all patients while also ensuring the quality of care provided by efficient management of resources, ensuring patients are in the appropriate level of care, supporting documentation, coding improvements and compliance and monitoring the appropriate use of diagnostic and therapeutic modalities. Responsibilities: Serving the health system through assisting Physician Advisors on a hospital and system level with clinical reviews and data analysis in collaboration with the Care Management, Utilization Review/Denials, Clinical Documentation Integrity, Coding, and Managed Care departments.
Senior Director of Utilization Management TurningPoint Healthcare Solutions LLCSenior Director of Utilization ManagementLake Mary, FLThe Senior Director serves as a key member of the Operations leadership team and partners closely with Clinical Operations, Quality, Technology, Product, Client Services, Implementation, Medical Policy/Coding and Growth teams to achieve organizational objectives and client commitments. Preferred Skills: Preferred skills include executive communication, client partnership, operational problem solving, process improvement, people leadership, change management, performance analytics, regulatory awareness, and the ability to lead through influence in a matrixed environment.
Medical Director of Case Management and Utilization Review - FT Days - MHM Memorial Healthcare SystemMedical Director of Case Management and Utilization Review - FT Days - MHMMiramar, FloridaAssists the Case Management staff in resolving patient care issues for referred cases, provides physician education, and assists the hospital and medical staff in developing and promoting resource management goals and objectives. This includes, but not limited to:Makes decisions on referred individual patient cases regarding pre-admission authorization, medical necessity and services/setting, appropriateness of admission, and continuation stay.
Inpatient Utilization Management Specialist Charlotte Behavioral Health CareInpatient Utilization Management SpecialistPUNTA GORDA, FLParticipate in daily treatment team meetings in Crisis Services programs for the purpose of identifying new patients and communicating with them to determine financial income information, behavioral health and Substance Abuse insurance coverage as well as prescription medication insurance coverage. Tuition reimbursement, Public Service Loan Forgiveness (PSLF) eligible, and Health Resources and Services Administration (HRSA) loan repayment eligible for qualifying staff.
Utilization Management Representative I (Miami, FL) Elevance HealthUtilization Management Representative I (Miami, FL)Miami, FloridaWe are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.
Utilization Management Representative I Elevance HealthUtilization Management Representative ITampa, FloridaWe are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.