TravelNurseSourceNewTravel 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.
TravelNurseSourceNewTravel Nurse RN - Utilization Review - $40 to $45 per hour in Fort Myers, FL TravelNurseSourceTravel Nurse RN - Utilization Review - $40 to $45 per hour in Fort Myers, FLFort Myers, FL$40–$45Develops individualized care plans, conducts assessments, ensures service delivery without gaps, and collaborates with providers and caregivers to promote quality and cost-effective healthcare outcomes. Responsible for assessing, coordinating, and managing long-term services and supports (LTSS) for members with complex medical needs.
TravelNurseSourceNewTravel Nurse RN - Utilization Review - $40 to $45 per hour in Wesley Chapel, FL TravelNurseSourceTravel Nurse RN - Utilization Review - $40 to $45 per hour in Wesley Chapel, FLWesley Chapel, FL$40–$45Develops individualized care plans, conducts assessments, ensures service delivery without gaps, and collaborates with providers and caregivers to promote quality and cost-effective healthcare outcomes. Responsible for assessing, coordinating, and managing long-term services and supports (LTSS) for members with complex medical needs.
Memorial Healthcare SystemMedical Director of Case Management and Utilization Review - FT Days ? MHM Memorial Healthcare SystemMedical Director of Case Management and Utilization Review - FT Days ? MHMHollywood, FLAssists 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.
TravelNurseSourceNewTravel Nurse RN - Utilization Review - $1,566 per week in Brooksville, FL TravelNurseSourceTravel Nurse RN - Utilization Review - $1,566 per week in Brooksville, FLBrooksville, FL$1,566–$1,566Benefits: 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.
TravelNurseSourceNewTravel Nurse RN - Utilization Review - $1,740 per week in Margate, FL TravelNurseSourceTravel Nurse RN - Utilization Review - $1,740 per week in Margate, FLMargate, FL$1,740–$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.
TravelNurseSourceNewTravel 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$1,693–$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.
Molina HealthcareNewField Nurse Practitioner (Panama City and Ocala Florida locations) Molina HealthcareField Nurse Practitioner (Panama City and Ocala Florida locations)Saint Petersburg, FL$88,453–$172,484 / yearProvides screening, preventive primary care and medical care services to members - primarily in non-clinical settings where members feel most comfortable, including in-home, community and nursing facilities and "pop up" clinics. See Molina Healthcare Privacy Policy at https://www.molinahealthcare.com/members/common/en-US/Pages/terms_privacy.aspx? and SonicJobs Privacy Policy at https://www.sonicjobs.com/us/privacy-policy and Terms of Use at https://www.sonicjobs.com/us/terms-conditions.
Molina HealthcareNewField Nurse Practitioner (Port Saint Lucie, FL) Molina HealthcareField Nurse Practitioner (Port Saint Lucie, FL)Port Saint Lucie, FL$88,453–$172,484 / yearJOB DESCRIPTION Job Summary Provides screening, preventive primary care and medical care services to members - primarily in non-clinical settings where members feel most comfortable, including in-home, community and nursing facilities and “pop up” clinics. See Molina Healthcare Privacy Policy at https://www.molinahealthcare.com/members/common/en-US/Pages/terms_privacy.aspx? and SonicJobs Privacy Policy at https://www.sonicjobs.com/us/privacy-policy and Terms of Use at https://www.sonicjobs.com/us/terms-conditions.
HCA Florida North Florida HospitalNewRN Case Manager HCA Florida North Florida HospitalRN Case ManagerGainesville, FLWe have an exciting opportunity for you to join HCA Florida North Florida Hospital which is part of the nation's leading provider of healthcare services, HCA Healthcare. Our hospital has an Accredited Chest Pain Center by ACC (American College of Cardiology) and is designated as a Blue Distinction Center for Spine Surgery and Bariatric Surgery.
ChenMedNurse Practitioner ChenMedNurse PractitionerJacksonville, FL$111,140–$158,771The 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.
OptumNewRegistered Nurse (PRN) OptumRegistered Nurse (PRN)Inverness, FL$30.82–$68.03 / hourQualityMakes initial and/or comprehensive nursing evaluation visits, ensures patients meet home health eligibility and medical necessity guidelines, determines primary focus of care, develops the plan of care within State guidelines with the physician, and submits accurate documentation. Actively participates in survey/survey readiness activities and performance improvement plans, works to reduce unnecessary patient hospitalizations, improve patient safety, and implements processes and best practices to ensure positive patient outcomes.
Encompass Health Rehabilitation Hospital of ClermontNewCase 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.
UF HealthNewCase Manager | Durbin Park | Full Time UF HealthCase Manager | Durbin Park | Full TimeSt. Johns, FLOverview: The Case Manager (CM) is an important member of the treatment team responsible for participating in the development of the patient's plan of care and facilitating efficient throughput, conducting utilization review, promoting appropriate utilization of resources, and identifying needs and establishing safe and appropriate discharge plans. The CM performs these functions throughout the care continuum by utilizing sound assessment skills and collaborating with the patient and their caregivers, Attending Physician, Utilization Review Coordinator, and other members of the treatment team.
TravelNurseSourceNewTravel 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.
TravelNurseSourceNewTravel Nurse RN - Case Manager - $1,620 to $1,800 per week in Fort Lauderdale, FL TravelNurseSourceTravel Nurse RN - Case Manager - $1,620 to $1,800 per week in Fort Lauderdale, FLFort Lauderdale, 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.
TravelNurseSourceNewTravel 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.
Memorial Healthcare SystemCase Manager, RN Memorial Healthcare SystemCase Manager, RNHollywood, FLMust be able to provide education and resources relevant to the effective progression of care, utilization of services, appropriate level of care, and safe patient transition to the patient/family and health care team. Complexity of Work: This role requires critical thinking skills, effective communication, decisive judgment, and the ability to build and foster positive relationships.
Memorial Healthcare SystemCase Manager - RN - Per Diem Memorial Healthcare SystemCase Manager - RN - Per DiemHollywood, FLMust be able to provides education and resources relevant to the effective progression of care, utilization of services, appropriate level of care, and safe patient transition to the patient/family and healthcare team. Complexity of Work: This role requires critical thinking skills, effective communication, decisive judgment, and the ability to build and foster positive relationships.
HCA Florida Fort Walton-Destin HospitalLaboratory 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.
ChenMedPrimary Care Physician ChenMedPrimary Care PhysicianJacksonville, FL$221,141–$315,915Plans 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. Works collaboratively with physicians, nurses, PT, social workers, family and key caregivers to transition the patient to a lower level of care as soon as medically appropriate.
Encompass HealthNewCase Manager Encompass HealthCase ManagerSaint Petersburg, FLJoin Encompass Health, where being a Case Manager goes beyond just a job; it positions you as a vital link between exceptional care and the transformative impact on each patient's journey. Our achievements include being named one of the "World's Most Admired Companies" and receiving the Fortune 100 Best Companies to Work For® Award, among other accolades, which is nothing short of amazing.
Encompass Health Rehabilitation Hospital of Central Florida – Sumter CountyNewCase Manager Encompass Health Rehabilitation Hospital of Central Florida – Sumter CountyCase ManagerWildwood, FLJoin Encompass Health, where being a Case Manager goes beyond just a job; it positions you as a vital link between exceptional care and the transformative impact on each patient's journey. Our achievements include being named one of the "World's Most Admired Companies" and receiving the Fortune 100 Best Companies to Work For® Award, among other accolades, which is nothing short of amazing.
Molina HealthcareNewClinical Pediatric Pharmacist (CPP) Molina HealthcareClinical Pediatric Pharmacist (CPP)ORLANDO, FL$80,412–$156,803.45 / yearConducts training as needed to Health Care Services leadership/nurse case managers on self-serve pharmacy resources (formulary lookup, pharmacy locator, etc) as well as articulates pharmacy management policies and procedures to pharmacy/health plan providers, Molina staff and others as needed. • Assists Health Care services leadership and nurse case managers in coordination of care for pharmacy-related issues as nurse case managers provide the necessary outbound health plan service support to members, their caregivers, and providers.
OptumNewSenior Practice Support Specialist OptumSenior Practice Support SpecialistTampa, FL$72,800–$130,000 / yearWellMed has more than 22,000+ primary care physicians, hospitalists, specialists, and advanced practice clinicians who excel in caring for 900,000+ older adults. This role is designed to drive value-based care performance and reduce avoidable utilization through proactive patient outreach, coordinated clinical interventions, and improved provider engagement.
HCA Florida Sarasota Doctors HospitalNewHospital 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.
UF HealthRN, Utilization Management | Utilization Management UF HealthRN, Utilization Management | Utilization ManagementThe Villages, FloridaEvaluates 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.
UF HealthRN, Utilization Management | Utilization Management | PRN UF HealthRN, Utilization Management | Utilization Management | PRNGainesville, FloridaAnalyzes utilization data to identify trends and opportunities for improvement, partnering with interdisciplinary teams to enhance care coordination. Evaluates patient medical records to determine the necessity and appropriateness of healthcare services in alignment with utilization management guidelines.
Impresiv HealthUtilization Management Nurse Impresiv HealthUtilization Management NurseDoral, FLThe Utilization Management Nurse (RN or LPN) is responsible for coordinating, monitoring, evaluating, and managing utilization review activities and authorization requests for members with complex medical and psychosocial needs. This position performs concurrent and retrospective reviews for inpatient, observation, and skilled nursing facility services, while supporting safe discharge planning and continuity of care.
University of Florida Health Science CenterRN, Utilization Management | Utilization Management University of Florida Health Science CenterRN, Utilization Management | Utilization ManagementSt. Augustine, 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.
GuideWell Mutual Holding CorpCMS and NCQA Utilization Management, RN - Florida Remote GuideWell Mutual Holding CorpCMS and NCQA Utilization Management, RN - Florida RemoteFLRemote$77,600–$126,100 / yearAs an employee, you will have access to: Medical, dental, vision, life and global travel health insurance; Income protection benefits: life insurance, short- and long-term disability programs; Leave programs to support personal circumstances; Retirement Savings Plan including employer match; Paid time off, volunteer time off, 10 holidays and 2 well-being days; Additional voluntary benefits available; and. As a Specialist, you will apply your discipline-specific knowledge and skills in utilization management, compliance, and quality reporting to support the Company's operations and ensure adherence to Centers for Medicare and Medicaid Services (CMS) and National Quality Care Assessment (NQCA) guidelines.
CVS Health CorpNewUtilization Management Nurse Consultant CVS Health CorpUtilization Management Nurse ConsultantWork At Home, FL$29.10–$62.32 / hourUtilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members. 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.
University of Florida Health Science CenterRN, Utilization Management University of Florida Health Science CenterRN, Utilization ManagementGainesville, FLServes as a resource to physicians; conducts admission and concurrent reviews; identifies patients who do not meet criteria and takes action to ensure the patient is placed in the most appropriate alternative level of care and determines the correct admission status and level of care for those patients who meet hospital admission criteria (ambulatory surgery, observation, and inpatient). Minimum Education and Experience Requirements: • Registered nurse (RN) with current Florida license • Three (3) years critical care nursing experience • Five (5) years medical-surgical nursing experience • Three (3) years utilization/case management or 3rd party payer work experience.
Baptist Health South Florida IncNewUtilization Review Registered Nurse, Case Management, FT, 07A-7:30P Local Remote-159563 Baptist Health South Florida IncUtilization Review Registered Nurse, Case Management, FT, 07A-7:30P Local Remote-159563Boca Raton, FLRemoteOur 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 Comprehensive health and wellness resources that go beyond traditional benefits A wellness program that can help employees eliminate their medical plan deductible, reducing out-of-pocket healthcare costs Tuition reimbursement to support continued learning and advancement And so much more Together, these benefits and others reflect our commitment to caring for our people, so they can build fulfilling careers with us while making a meaningful impact every day. 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.
University of Florida Health Science CenterUtilization Reviewer-NE | Utilization Management | PRN | Variable Shift University of Florida Health Science CenterUtilization Reviewer-NE | Utilization Management | PRN | Variable Shiftgainesville, FLExperience:Three (3) years of critical care nursing experience,OR five (5) years of medical-surgical nursing experience,OR three (3) years of utilization/case management or third-party payer work experience. Work Hours & Flexibility:Scheduled work hours and days may vary depending on departmental needs as determined by the department director/manager.
SavianceNewUtilization Management Professional SavianceUtilization Management ProfessionalPensacola, FLCertifications: Must have one of the following: LCSW - Licensed Clinical Social Worker, LISAC - Licensed Independent Substance Abuse Counselor, LMFT - Licensed Marriage and Family Therapist, LMHP - Licensed Mental Health Professional, LPC - Licensed Professional Counselor, LPN - Licensed Practical Nurse, LSW - Licensed Social Worker, RN - Registered Nurse, State and/or Compact State Licensure . Associates - Nursing, Bachelors - Nursing, Bachelors - Social Work, Social Work Masters - Social Work, LISAC - Licensed Independent Substance Abuse Counselor certification, LCSW - Licensed Clinical Social Worker, LMHP - Licensed Mental Health Professional, LPC - Licensed Professional Counselor, LMFT - Licensed Marriage and Family Therapist.
Careers Integrated ResourcesNewUtilization Management Professional Careers Integrated ResourcesUtilization Management ProfessionalMiami, FLReviews 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. · Provides information to enrolees, providers, and internal staff regarding covered and non-covered benefits, community resources, agency programs, and company policies and procedures and criteria.
Elevance Health IncUtilization Management Representative I Elevance Health IncUtilization Management Representative ITampa, FLAdditional expectations to include but not limited to: Proficient in maintaining focus during extended periods of sitting and handling multiple tasks in a fast-paced, high-pressure environment; strong verbal and written communication skills, both with virtual and in-person interactions; attentive to details, critical thinker, and a problem-solver; demonstrates empathy and persistence to resolve caller issues completely; comfort and proficiency with digital tools and platforms to enhance productivity and minimize manual efforts. For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.
Elevance Health IncUtilization Management Representative I (US) Elevance Health IncUtilization Management Representative I (US)Tampa, FLAdditional expectations to include but not limited to: Proficient in maintaining focus during extended periods of sitting and handling multiple tasks in a fast-paced, high-pressure environment; strong verbal and written communication skills, both with virtual and in-person interactions; attentive to details, critical thinker, and a problem-solver; demonstrates empathy and persistence to resolve caller issues completely; comfort and proficiency with digital tools and platforms to enhance productivity and minimize manual efforts. We 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.
Molina HealthcareNewProgram Manager, Healthcare Services (SQL & Utilization Management Data) Molina HealthcareProgram Manager, Healthcare Services (SQL & Utilization Management Data)Tampa, FLRegistered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Advanced Practice Social Worker (APSW), Certified Health Education Specialist (CHES), Licensed Professional Counselor (LPC), Licensed Professional Clinical Counselor (LPCC) or Licensed Marriage and Family Therapist (LMFT). Collaboratively plans and executes internal healthcare services projects and programs involving department or cross-functional teams of subject matter experts - delivering products from the design process to completion.
Molina HealthcareNewSupervisor, Healthcare Services (Utilization Management) Molina HealthcareSupervisor, Healthcare Services (Utilization Management)Miami, FL$66,456–$129,590 / yearRegistered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Clinical Counselor (LPCC), or Licensed Master of Social Work (LMSW). • At least 5 years health care experience, and at least 2 years of managed care experienced in one or more of the following areas: utilization management, care management, care transitions, behavioral health, long-term services and supports (LTSS), or equivalent combination of relevant education and experience.
Dane Street, LLCNewUtilization Management, Clinical QA Supervisor Dane Street, LLCUtilization Management, Clinical QA Supervisorwest palm beach, FLWe process over 200,000 insurance claims annually for leading national and regional Workers’ Compensation, Disability, Auto, and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers, and Pharmacy Benefit Managers. We provide customized Independent Medical Exams and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.
AdventHealthNewUtilization Mgmt RN EX AdventHealthUtilization Mgmt RN EXOrlando, 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. Demonstrates working knowledge and understanding of state and federal guidelines pertinent to care management, as well as current procedural terminology (CPT codes and inpatient-only procedures.
University of MiamiNurse Utilization Review Supervisor University of MiamiNurse Utilization Review SupervisorMiami, FLParticipates in the development, implementation, and evaluation of the continuum of care: Facilitate patient access, assessing patient needs, ensuring that patients are smoothly transitioned from one care setting to the next, providing information to patients, families, and other providers who are receiving patient, disseminating case management, utilization management activities to appropriate members of the health care team, documenting treatment plan, discharge plan and family/guardian discussions in appropriate place in the medical record. Educates, coordinates, and provides information to members of the multidisciplinary healthcare team who can assist and/or improve discharge planning when knowledge deficit identified; Enhances professional growth and development through participation in educational programs, current literature, in-service education, conferences, seminars, and workshops when needed.
Healthcare Recruitment PartnersRN Senior Director of Case Management Healthcare Recruitment PartnersRN Senior Director of Case ManagementOrlando, FLThe Senior Director is responsible for driving seamless Care Coordination, Discharge Planning, Utilization Management, and Transitions of Care while partnering closely with physicians, nursing leadership, and executives to optimize patient outcomes, reduce readmissions, and ensure regulatory compliance. The RN Senior Director of Case Management serves as a subject matter expert in Case Management, demonstrating solid leadership, trust-building, team building, and Change Management abilities to drive departmental success and initiatives.
Healthcare Recruitment PartnersRN Director Case Management Healthcare Recruitment PartnersRN Director Case ManagementLake Nona Area, FLThe RN Director of Case Management serves as a subject matter expert in Case Management, demonstrating solid leadership, trust-building, team building, and Change Management abilities to drive departmental success and initiatives. The RN Director of Case Management has an executive presence, excellent communication and presentation skills, proven motivational leadership, and a strong record of delivering results and meeting goals.
Sarasota Memorial Health Care SystemUtilization Mgmt Case Mgr II Sarasota Memorial Health Care SystemUtilization Mgmt Case Mgr IISarasota, FloridaWhen potential denials for payment or level of care arise, the UMCM collaborates with the floor ICM staff, Revenue Cycle, involved physicians and/or the Physician Advisors (PA) as needed to attain second level review/approval to effectively overturn the denial or help determine appropriate transition for the patient. UMCM interact extensively with clinical staff throughout the hospital, other ICM staff, physicians, payers, and hospital financial staff in order to achieve appropriate level of care or placement authorizations, and to avoid denials.
Orlando Health Ventures l LLCRN Care Manager Case Management - Bayfront Hospital St. Petersburg Florida Orlando Health Ventures l LLCRN Care Manager Case Management - Bayfront Hospital St. Petersburg FloridaSt. Petersburg, FLJob Overview Promotes and facilitates effective management of hospital resources from admission to discharge, collaborating with the assigned clinical team to identify patients most likely to benefit from care coordination services, including assessing patients risk factors and the need for care coordination, clinical utilization management, and the transition to the next appropriate level of care. Orlando Health Bayfront Hospital is part of the Orlando Health system of care, which includes award-winning hospitals and ERs, specialty institutes, urgent care centers, primary care practices, and outpatient facilities that span Floridas east to west coasts, Central Alabama, and Puerto Rico.
TriWest Healthcare AllianceUtilization Clinical Reviewer TriWest Healthcare AllianceUtilization Clinical ReviewerTampa, FLRemoteFull timeApplies clinical knowledge to make determinations for preauthorization, inpatient and continued stay reviews for Behavioral Health and Medical/Surgical requests to establish medical necessity, benefit coverage, appropriateness of quality of care, and length of stay or care plan. The Utilization Management Clinical Review nurse reviews and makes decisions about the appropriateness and level of beneficiary care being provided in an effort to provide cost effective care and ensure proper utilization of resources.