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.
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 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.
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.
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).
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.
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.
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.
Utilization Review Specialist Senior BayCare Health SystemUtilization Review Specialist SeniorTampa, FLThe Utilization Review Specialist Senior responsibilities include: Functions as the primary liaison between the funding agents and all other related parties to ensure appropriate level of care through comprehensive concurrent review for medical necessity of outpatient observation and inpatient stays and the utilization of ancillary services. Our network consists of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers, and thousands of physicians.
Utilization Review Coordinator Lakeview Health GroupUtilization Review CoordinatorJacksonville, FLMental Health Support - Improved access to services and a new Employee Assistance Program (EAP) featuring digital wellness tools like Cognitive Behavioral Therapy (CBT) modules and wellness coaching. This position collaborates closely with healthcare providers, insurance companies, and case managers to facilitate timely approvals and optimize patient outcomes.
DIR - UTILIZATION REVIEW / MGMT University Health Services IncDIR - UTILIZATION REVIEW / MGMTJACKSONVILLE, FLResponsibilities include interviewing, hiring, and training employees; planning assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems Must be a Registered Nurse, and/or have a Bachelor's Degree in Social Work or Psychology or equivalent education and experience in Utilization Review/ Management. Operating acute care hospitals, behavioral health facilities, outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located all over the U.S. States, Washington, D.C., Puerto Rico and the United Kingdom.
PRN UTILIZATION REVIEW COORDINATOR University Health Services IncPRN UTILIZATION REVIEW COORDINATORJACKSONVILLE, FL$26–$37 / weekResponsibilities We are pleased to announce the following available position: PRN Utilization Review Coordinator, including weekends $26-$37 This position is responsible for monitoring the treatment activities offered to the patient, interfacing with the treatment team/managed care organizations to ensure quality patient care and collaborating with referring professionals for continuity of care. Operating acute care hospitals, behavioral facilities, outpatient facilities and ambulatory care access points, and insurance offering, a physician network and various related services located all over the United States, Washington, DC, Puerto Ricco and the United Kingdom.
Utilization Review Coordinator Bradford Health Services, LLCUtilization Review CoordinatorJacksonville, FLMental Health Support - Improved access to services and a new Employee Assistance Program (EAP) featuring digital wellness tools like Cognitive Behavioral Therapy (CBT) modules and wellness coaching. This position collaborates closely with healthcare providers, insurance companies, and case managers to facilitate timely approvals and optimize patient outcomes.
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.
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 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| 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.
Utilization Review Care Manager - Must have 3 years in IQ/MCG Orlando HealthUtilization Review Care Manager - Must have 3 years in IQ/MCGOrlando, FloridaFull timePromotes 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 to include assessing patients’ risk factors and the need forcare coordination, clinical utilization management and the transition to the next appropriate level of care. o Care coordination that includes admitting diagnosis/ medical history, current treatments, age, payment source, resources, support systems, anticipated needs, expected length of stay, appropriate level of service, special/ personal needs, and other relevant information.
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 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| 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.
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 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.
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.
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.
Clinical Review Nurse - Remote ARC GroupClinical Review Nurse - RemoteJacksonville, FLORIDARemote90% of time will be spent on one or more of the following activities depending on assignments: Review and analyze pre and post pay complex health care claims from a medical perspective, inclusive of prior authorization: Perform clinical review work as assigned; may provide guidance to other team members and accurately interpret and apply broad CMS guidelines to specific and highly variable situations. The incumbent applies clinical knowledge to assess the medical necessity, level of services and appropriateness of care which may include cases requiring prior authorization, complex pre-payment medical review or post-payment medical review.
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.
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.
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/ .
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.
Care Review Clinician (RN) Remote Molina Healthcare IncCare Review Clinician (RN) RemoteFLRemoteResponsible 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.
Clinical Review Nurse TurningPoint HealthcareClinical Review NurseLake Mary, Florida$62,000–$68,000 / yearTurningPoint Healthcare Solutions is a rapidly growing and innovative healthcare company that supports several large national health plans to improve the quality and affordability of healthcare patients receive. As a Utilization Review Nurse, you will utilize your critical thinking skills, clinical expertise and judgement along with established medical criteria to perform first level clinical review for select procedures that require medical necessity authorization.
NewRN, Clinical Review Specialist/DRG and Medical Necessity Appeals (FT/REMOTE) CorroHealthRN, Clinical Review Specialist/DRG and Medical Necessity Appeals (FT/REMOTE)FloridaRemoteSpecific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
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.
Medical Review Nurse - CMS RAC (Government audits) Performant Healthcare IncMedical Review Nurse - CMS RAC (Government audits)Plantation, FLRemote$81,000–$90,000 / yearRegularly sits at a desk during scheduled shift, uses office phone or headset provided by the Company for phone calls, making outbound calls and answering inbound return calls using an office phone system; views a computer monitor, types on a keyboard and uses a computer mouse. Deployed by over 75 health plans, including many of the top 20, and representing more than 170 million lives, Machinify's AI operating system, combined with proven expertise, untangles healthcare data to deliver industry-leading speed, quality, and accuracy.
Medical Review Nurse - CMS RAC (Government audits) PerformantMedical Review Nurse - CMS RAC (Government audits)Plantation, FloridaRemoteRegularly sits at a desk during scheduled shift, uses office phone or headset provided by the Company for phone calls, making outbound calls and answering inbound return calls using an office phone system; views a computer monitor, types on a keyboard and uses a computer mouse. Deployed by over 75 health plans, including many of the top 20, and representing more than 170 million lives, Machinify’s AI operating system, combined with proven expertise, untangles healthcare data to deliver industry-leading speed, quality, and accuracy.
Utilization Physician Reviewer BayCare Health SystemUtilization Physician ReviewerTampa, FLServes as an integral team member to assess and influence clinical resource utilization in the acute care setting through collegial interaction with Utilization Review, Case Management, and Clinical Providers while aligning with organizational initiatives and priorities. The role of the Utilization Physician Reviewer is to optimize utilization physician review coverage resulting in reduction of inappropriate prolonged observation stays and improved patient throughput and progression of care.
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 Reviewer Mental Health Resource CenterUtilization Management ReviewerJacksonville, FLOutpatient 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.