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.
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.
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.
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.·
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.
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.
NewUtilization 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.
NewUtilization Management Professional, Integrated Resources, IncUtilization Management Professional,Miami, FloridaFull timeJob DescriptionUnder 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. Our team works hard to deliver a tailored approach for each and every client, critical in matching the right employers with the right candidates.
Utilization Management Representative I (Miami, FL) Elevance Health IncUtilization Management Representative I (Miami, FL)Miami, FLURAC 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. 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.
Utilization Management Representative I (US) Elevance Health IncUtilization Management Representative I (US)Miami, 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.
Manager, Utilization Review Health Business Solutions LLCManager, Utilization ReviewCooper City, FLIf you are an experienced and visionary nurse leader who is passionate about improving patient care and outcomes, we invite you to apply for the Utilization Review Nurse Manager position. The Manager, Utilization Review is responsible for overseeing the daily operations of the Utilization Review for one of our clients and leading a team of Utilization Review Nurses.
Medical Management Clinician Senior -Licensed Nurse Elevance Health IncMedical Management Clinician Senior -Licensed NurseMiami, FLConducts and may approve pre-certification, concurrent, retrospective, out of network and/or appropriateness of treatment setting reviews by utilizing appropriate medical policies and clinical guidelines in compliance with department guidelines and consistent with the members eligibility, benefits and contract. 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.
Medical Management Nurse Elevance Health IncMedical Management NurseMiami, FL$75,772–$113,658 / yearHow you will make an impact: Utilizes nursing judgment and reasoning to analyze members' clinical information, interface with healthcare providers, make assessments based on clinical presentation, and apply clinical guidelines and/or policies to evaluate medical necessity. The Medical Management Nurse is responsible for review of the most complex or challenging cases that require nursing judgment, critical thinking, and holistic assessment of member's clinical presentation to determine whether to approve requested service(s) as medically necessary.
Care Management Discharge Plan Coordinator, Case Management, FT, 8A-4:30P Baptist Health South Florida IncCare Management Discharge Plan Coordinator, Case Management, FT, 8A-4:30PSouth Miami, FL$18.87–$23.96 / hourSpecific duties include frequent interactions with care managers, patients, payers, and community care providers, data entry and analysis related to insurance coverage and availability of resources, coordination of post discharge services including home health care, durable medical equipment, nursing homes, hospital transfers, transportation and services for the indigent population. Our 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.
RN Case Manager - FT - Days - $10K Sign on Bonus - MRH South Broward Hospital DistrictRN Case Manager - FT - Days - $10K Sign on Bonus - MRHHollywood, FLEducation and Certification Requirements: Accredited Program: Nursing (Required) BLS American Heart E-Card (BLS AHA ECARD) - American Heart Association (AMERICAN HEART) BLS American Heart RQI E-Card (BLS AHA-RQI ECARD) - American Heart Association (AMERICAN HEART) BLS Cert American Heart_non ecard (BLS AHA) - American Heart Association (AMERICAN HEART) BLS Certification Grace (BLS GRACE) - Employee Grace Period for Essential Credential (GRACE) BLS Cert Red Cross (BLS RC) - Red Cross (RED CROSS) Registered Nurse Compact License (RN LICENSE COMPACT) - Compact RN Multistate Registered Nurse License (RN LICENSE) - State of Florida (FL). Key responsibilities are to partner with the healthcare team to ensure all aspects of the patient's needs, clinical, psychosocial, and financial are adequately addressed in the transition of the care plan and to manage the patient's timely progression of care and safe transition to the next most appropriate level of care.
NewSenior Registered Nurse Integrated Resources, IncSenior Registered NurseMiami, FloridaFull timeReceives requests for authorization of services, including inpatient hospital admissions, inpatient rehabilitation services, Skilled Nursing admission), home care home infusion services, outpatient and/or inpatient elective surgery, and referrals for specialty physician consultation with non-participating physician offices. Job DescriptionResponsible for completing medical necessity reviews using KFHP policies and procedures, reviewing inpatient and outpatient elective procedures requiring prior authorization, inpatient hospital stays, and requesting, assessing and appropriately channeling/facilitating discharge planning requests Consistently applies medical health benefit policy and medical management guidelines to authorize services.
Concurrent Review Nurse Palm Medical CentersConcurrent Review NurseCoral Gables, FLFull timeThis includes reviewing inpatient admissions and ongoing hospital stays to determine medical necessity, appropriateness of care, and length of stay in accordance with clinical guidelines and payer requirements. The Concurrent Review Nurse is responsible for performing utilization management activities to ensure medical services are delivered effectively, efficiently, and appropriately.
Care Review Clinician (RN) - Remote in FL Molina Healthcare IncCare Review Clinician (RN) - Remote in FLFLRemoteResponsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience.
Manager, Case Management University of MiamiManager, Case ManagementMiami, FLESSENTIAL FUNCTIONS: Technical Duties: Proficient in math applications and use of spreadsheet programs; ability to operate word processing equipment; advanced written communication skills including grammar, spelling, and punctuation; thorough understanding of all regulations regarding personnel practices. Manage the observation patient process, assist the Admitting department with bed assignment and appropriate placement, conduct InterQual reviews, EQ Health reviews, coordinate monthly statistics for data reporting-Avoidable data, denial data and Physician Advisor reviews, HINN Data.
LPN Care Coordinator (BHI) MedElite Group, LLC.LPN Care Coordinator (BHI)Hollywood, FL$30.75–$33 / hourInfinite Medical P.C. is a nationwide network of advanced practice providers and specialty clinicians committed to delivering high-quality, proactive care directly to residents in skilled nursing and long-term care facilities. Our partnership with MedElite Healthcare Management Group empowers us to focus on what matters most: providing compassionate, personalized care that meets the unique needs of each resident.
Registered Nurse Team Leader MedSurg Mount Sinai Medical Center of FloridaRegistered Nurse Team Leader MedSurgMiami Beach, FloridaCoordinates unit operations for assigned shift, subject to the review of the Unit Director/Manager, including scheduling, patient assignments, monitoring of unit activities, and coordination among other departments to ensure effectiveness of operation and the delivery of quality care. We offer the latest in advanced medicine, technology, and comfort in 12 facilities across Miami-Dade (including our 674-bed main campus facility) and Monroe Counties, with 38 medical services, including cancer care, 24/7 emergency care, orthopedics, cardiovascular care, and more.
LPN Care Coordinator (BHI) MedElite GroupLPN Care Coordinator (BHI)Hollywood, FloridaInfinite Medical P.C. is a nationwide network of advanced practice providers and specialty clinicians committed to delivering high-quality, proactive care directly to residents in skilled nursing and long-term care facilities. Our partnership with MedElite Healthcare Management Group empowers us to focus on what matters most: providing compassionate, personalized care that meets the unique needs of each resident.
Nurse Reviewer 1 Elevance Health IncNurse Reviewer 1Miami, FLMinimum Requirements: Requires AS in nursing and minimum of 3 years of clinical nursing experience in an ambulatory or hospital setting or minimum of 1 year of prior utilization management, medical management and/or quality management, and/or call center experience; or any combination of education and experience, which would provide an equivalent background. Through work experience and mentoring learns to conduct medical necessity clinical screenings of preauthorization requests to assess the medical necessity of diagnostic imaging procedures, out of network services, and appropriateness of treatment.
Case Management Director Encompass Health CorpCase Management DirectorSunrise, 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.
Manager, Clinician Appeals (Active RN License REQ''''D) CorroHealth IncManager, Clinician Appeals (Active RN License REQ''''D)FLRemoteThe ideal candidate WILL HAVE an active, unrestricted RN license (compact preferred), will be a strong communicator who can confidently engage with hospital executives, physicians, and clients to explain medical scenarios, discuss denial trends, and provide clear education on documentation improvements. This individual will lead high-performing clinical teams in the development of clinically accurate, persuasive, and compliant appeal communications to payers, while ensuring operational excellence, clinical integrity, and alignment with financial goals.
NewMedical Management Clinician Elevance Health IncMedical Management ClinicianMiami, FLThrough our distinct clinical expertise, digital capabilities, and broad access to specialty medications across a wide range of conditions, we deliver an elevated experience, affordability, and personalized support throughout the consumer's treatment journey. Conducts and may approve precertification, concurrent, retrospective, out-of-network, and/or appropriateness of treatment setting reviews by assessing clinical information against appropriate medical policies, clinical guidelines, and the relevant benefit plan/contract.
NewClinical Resource Manager RN Actalent IncClinical Resource Manager RNMiami, FL$39–$46 / hourThis role serves as a key liaison between supply chain, clinical leadership, physicians, finance, vendors, and executive stakeholders, ensuring that product decisions support high-quality, safe, and cost-effective patient care. The Clinical Resource Manager works closely with clinical staff, physicians, executive leadership, supply chain teams, and vendors, engaging in frequent meetings, committee sessions, and collaborative planning.
Manager, Third Party Risk Management (Clinical_RN)) Centene Corporation GroupManager, Third Party Risk Management (Clinical_RN))FL$87,700–$157,800 / yearSupports internal and external audits related to third party compliance oversight by maintaining appropriate documentation, coordinating with third parties, performing quality review of submissions, and preparing presentations to stakeholders. Develops, implements, and maintains third party risk management framework, policies, and procedures for third parties supporting care management, population health, utilization management and other clinical operations.
Home Care Supervisor, RN BayCare Health SystemHome Care Supervisor, RNFLAs a Home Care Supervisor, RN, you will play a pivotal role in the leadership of assigned patient services, ensuring that our dedicated team members meet and exceed all credentials required for their positions. Our network consists of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers and thousands of physicians.
NewMedical Review Nurse (RN) - UM/Appeals experience Molina Healthcare IncMedical Review Nurse (RN) - UM/Appeals experienceFlorida, FLREQUIRED QUALIFICATIONS: At least 2 years clinical nursing experience, including at least 1 year of utilization review (prospective, retrospective and concurrent clinical review), medical claims review, long-term services and supports (LTSS), claims auditing, medical necessity review and/or coding experience, or equivalent combination of relevant education and experience. Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level of care utilizing MCG/InterQual, state/federal guidelines, billing and coding regulations, and Molina policies; validates the medical record and claim submitted support correct coding to ensure appropriate reimbursement to providers.
Registered Nurse - Schools Team Select Home Care LLCRegistered Nurse - SchoolsFL$28–$30 / hourEnsures that the following information/instruction is given in writing to the patient/caregiver/representative: Visit schedule with frequency of visits, complete Medication Profile, any treatments to be administered by agency staff (POC), any other pertinent instruction related to the patient's care needs, and name and contact information of the agency's Clinical Manager. Join Team Select Home Care as a Registered Nurse (RN), where you'll bring comfort and confidence to families by delivering compassionate one-on-one care to medically complex children and adults in the comfort of their homes.
Registered Nurse- Schools Team Select Home Care LLCRegistered Nurse- SchoolsMiami, FL$23–$25 / hourEnsures that the following information/instruction is given in writing to the patient/caregiver/representative: Visit schedule with frequency of visits, complete Medication Profile, any treatments to be administered by agency staff (POC), any other pertinent instruction related to the patient's care needs, and name and contact information of the agency's Clinical Manager. Join Team Select Home Care as a Registered Nurse (RN), where you'll bring comfort and confidence to families by delivering compassionate one-on-one care to medically complex children and adults in the comfort of their homes.
NewER Point of Entry - RN Case Manager - FT - Days - 10K Sign on Bonus - MHW South Broward Hospital DistrictER Point of Entry - RN Case Manager - FT - Days - 10K Sign on Bonus - MHWPembroke Pines, FLEducation and Certification Requirements: Accredited Program: Nursing (Required)BLS American Heart E-Card (BLS AHA ECARD) - American Heart Association (AMERICAN HEART), BLS American Heart RQI E-Card (BLS AHA-RQI ECARD) - American Heart Association (AMERICAN HEART), BLS Cert American Heart_non ecard (BLS AHA) - American Heart Association (AMERICAN HEART), BLS Certification Grace (BLS GRACE) - Employee Grace Period for Essential Credential (GRACE), BLS Cert Red Cross (BLS RC) - Red Cross (RED CROSS), Registered Nurse Compact License (RN LICENSE COMPACT) - Compact RN Multistate, Registered Nurse License (RN LICENSE) - State of Florida (FL). Responsibilities: Provides support for other entry points as indicated, which includes: Responding to requests about status in the PACU, and supporting the Care Coordination Center in decision making regarding acute care transfers and direct admits.
RN Pediatric Case Manager - FT - Days - $10k Sign on Bonus - JDCH South Broward Hospital DistrictRN Pediatric Case Manager - FT - Days - $10k Sign on Bonus - JDCHHollywood, FLEducation and Certification Requirements: Accredited Program: Nursing (Required)BLS American Heart E-Card (BLS AHA ECARD) - American Heart Association (AMERICAN HEART), BLS American Heart RQI E-Card (BLS AHA-RQI ECARD) - American Heart Association (AMERICAN HEART), BLS Cert American Heart_non ecard (BLS AHA) - American Heart Association (AMERICAN HEART), BLS Certification Grace (BLS GRACE) - Employee Grace Period for Essential Credential (GRACE), BLS Cert Red Cross (BLS RC) - Red Cross (RED CROSS), Registered Nurse Compact License (RN LICENSE COMPACT) - Compact RN Multistate, Registered Nurse License (RN LICENSE) - State of Florida (FL). Key responsibilities are to partner with the healthcare team to ensure all aspects of the patient's needs, clinical, psychosocial, and financial are adequately addressed in the transition of the care plan and to manage the patient's timely progression of care and safe transition to the next most appropriate level of care.
RN Case Manager - FT - Days - $10K Sign on Bonus - MHW South Broward Hospital DistrictRN Case Manager - FT - Days - $10K Sign on Bonus - MHWPembroke Pines, FLEducation and Certification Requirements: Accredited Program: Nursing (Required)BLS American Heart E-Card (BLS AHA ECARD) - American Heart Association (AMERICAN HEART), BLS American Heart RQI E-Card (BLS AHA-RQI ECARD) - American Heart Association (AMERICAN HEART), BLS Cert American Heart_non ecard (BLS AHA) - American Heart Association (AMERICAN HEART), BLS Certification Grace (BLS GRACE) - Employee Grace Period for Essential Credential (GRACE), BLS Cert Red Cross (BLS RC) - Red Cross (RED CROSS), Registered Nurse Compact License (RN LICENSE COMPACT) - Compact RN Multistate, Registered Nurse License (RN LICENSE) - State of Florida (FL). Key responsibilities are to partner with the healthcare team to ensure all aspects of the patient's needs, clinical, psychosocial, and financial are adequately addressed in the transition of the care plan and to manage the patient's timely progression of care and safe transition to the next most appropriate level of care.
Registered Nurse - Case Manager (Remote) GuideWell Mutual Holding CorpRegistered Nurse - Case Manager (Remote)FLRemote$71,200–$115,700 / yearUtilizing a member-centric approach they assist members and their families understand and manage their disease process by: reinforcing the physicians' plan of treatment, promoting healthy behaviors and lifestyle changes, and providing education and tools to promote self-management to improve health outcomes and reduce overall costs. Promote healthy lifestyles, assist in strengthening the patient-physician relationship, encourage behavior and lifestyle changes to realize a better quality of life, for individuals with identified chronic conditions, costly and/or catastrophic illnesses.
Telephonic Nurse Case Manager II Elevance Health IncTelephonic Nurse Case Manager IIMiami, FL$79,464–$119,196 / yearThe Telephonic Nurse Case Manager II is responsible for care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. 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.
RN Case Manager Team Select Home Care LLCRN Case ManagerFL$70,000–$85,000 / yearEnsures that the following information/instruction is given in writing to the patient/caregiver/representative: visit schedule with frequency of visits, complete medication profile, any treatments to be administered by agency staff (POC), any other pertinent instruction related to the patient's care needs, name and contact information of the agency's Clinical Manager. Acts as an advocate for patient welfare and coordinates care between patients, their families/caregivers and/or their authorized representative, the agency and other healthcare providers/facilities/ outside agencies.
Registered Nurse Case Manager PRN HCA Healthcare IncRegistered Nurse Case Manager PRNMiami, FLWhat qualifications you will need: RN with current state licensure; BSN preferred Three years' clinical acute care (i.e. Med-Surg, Tele, PACU, ICU, CVICU etc) hospital nursing experience required with preference given to those with 2 years of case management experience or 2 years of critical care experience Certification in case management or utilization review preferred InterQual experience preferred Benefits HCA Florida Mercy Hospital, offers a total rewards package that supports the health, life, career and retirement of our colleagues. As a Registered Nurse Case Manager PRN, your voice to influence patient care is valued and empowered at every turn -whether through open, collaborative relationships with your direct manager or more formal opportunities through hospital councils and national nursing initiatives.
Registered Nurse Behavioral Health Mount Sinai Medical Center of FloridaRegistered Nurse Behavioral HealthMiami Beach, FloridaAssumes accountability for completion of delegated tasks during assigned shift, including but not limited to: Ensuring that each patient's general hygiene needs are met daily Dressing changes using aseptic techniques Bedside glucose monitoring according to policy Administering oxygen therapy according to physician order. We offer the latest in advanced medicine, technology, and comfort in 12 facilities across Miami-Dade (including our 674-bed main campus facility) and Monroe Counties, with 38 medical services, including cancer care, 24/7 emergency care, orthopedics, cardiovascular care, and more.
VP, Clinical Policy & Risk Management Humana IncVP, Clinical Policy & Risk ManagementFort Lauderdale, FLPartner closely with clinical, operational, compliance, and business leaders to ensure learning content is aligned to regulatory requirements, clinical processes, system functionality, and business priorities; establish scalable onboarding and learning pathways, optimize learner experience across platforms, and use performance data, audit findings, and operational insights to strengthen adoption, reduce risk, and improve readiness and effectiveness of the clinical workforce. The mission of the Medicare and Medicaid Operational Risk Management Department is to partner with CM/UM teams to drive operational compliance, member access to care, and efficiency, while proactively identifying and managing risks related to care and utilization management.
Registered Nurse (RN) - Pediatric & Adult Home Health | Private Duty Nursing Team Select Home Care LLCRegistered Nurse (RN) - Pediatric & Adult Home Health | Private Duty NursingFL$23–$28 / hourEnsures that the following information/instruction is given in writing to the patient/caregiver/representative: Visit schedule with frequency of visits, complete Medication Profile, any treatments to be administered by agency staff (POC), any other pertinent instruction related to the patient's care needs, and name and contact information of the agency's Clinical Manager. Join Team Select Home Care as a Registered Nurse (RN), where you'll bring comfort and confidence to families by delivering compassionate one-on-one care to medically complex children and adults in the comfort of their homes.
Registered Nurse (RN) – Pediatric & Adult Home Health | Private Duty Nursing Team Select Home CareRegistered Nurse (RN) – Pediatric & Adult Home Health | Private Duty NursingMiami, FloridaEnsures that the following information/instruction is given in writing to the patient/caregiver/representative: Visit schedule with frequency of visits, complete Medication Profile, any treatments to be administered by agency staff (POC), any other pertinent instruction related to the patient’s care needs, and name and contact information of the agency’s Clinical Manager. Join Team Select Home Care as a Registered Nurse (RN), where you’ll bring comfort and confidence to families by delivering compassionate one-on-one care to medically complex children and adults in the comfort of their homes.
Registered Nurse Case Manager HCA Healthcare IncRegistered Nurse Case ManagerPlantation, FLWhat qualifications you will need:RN with current state licensure; BSN preferredThree years' clinical acute care (i.e. Med-Surg, Tele, PACU, ICU, CVICU etc) hospital nursing experience required with preference given to those with 2 years of case management experience or 2 years of critical care experienceCertification in case management or utilization review preferredInterQual experience preferredBenefits HCA Florida Westside Hospital, offers a total rewards package that supports the health, life, career and retirement of our colleagues. Job Summary and QualificationsThe Case Manager (CM) ensures high-quality, patient-centered care by managing Rehabilitative care to ensure optimum outcomes.
Concurrent Review Nurse (Weekend Shift) Leon Health IncConcurrent Review Nurse (Weekend Shift)Doral, FLUnder the general supervision of the Director of Health Services, the Concurrent Review Nurse is responsible for ensuring the delivery of medically necessary, high-quality, and cost-effective care. Issue authorizations for inpatient admissions, outpatient services, and post-service requests to providers, facilities, and members as applicable.
Director, Case Management-Case Mgmt-FT-Days-BHMC #30273 Broward HealthDirector, Case Management-Case Mgmt-FT-Days-BHMC #30273Fort Lauderdale, FLSummary: The Director has overall responsibility for hospital utilization, performance improvement and operational management of the Case Management Department in order to promote effective utilization of hospital resources, ensure processes support appropriate reimbursement for services rendered and that patients receive quality care in the most cost-effective manner. Credentials: Licensed as a Registered Nurse in the State of Florida or holds a Florida multi-state nursing license; or able to obtain license prior to start is required.
Radiology Nurse Manager - Northern Satellites - Full Time University of MiamiRadiology Nurse Manager - Northern Satellites - Full TimeNorth Miami, FLUHealth-University of Miami Health System, South Florida's only university-based health system, provides leading-edge patient care powered by the ground breaking research and medical education at the Miller School of Medicine. Proven track record of building relationships with physicians, direct reports and key staff members throughout the hospital Excellent English verbal/written skills are necessary.