RN Care Review Clinician - Utilization & Prior Auth
$26.41 - $61.79 per hourMolina Healthcare of Illinois
Uloop Inc. is looking for a Clinical Reviewer in Miami, Florida, to provide support for clinical member services review assessment processes. Responsibilities include assessing services, analyzing clinical requests, and ensuring compliance with guidelines. The ideal candidate will be a Registered Nurse with an active license and at least 2 years of relevant experience. The position offers a competitive hourly pay range between $26.41 and $61.79, depending on experience and location. #J-18808-Ljbffr Molina Healthcare
Vacancy posted 3 days ago
Similar jobs that could be interesting for youBased on the RN Care Review Clinician - Utilization & Prior Auth in Miami, FL vacancy
- ...Florida PACE (Program of All-Inclusive Care for the Elderly) Centers, the largest PACE... ...Pace Program sites. Job Title: Utilization Review RN Job Summary The Utilization RN... ...settings with strong assessment skills. ~ Prior Utilization Management/Review or...SuggestedFull timePart timeWork at officeLocal areaRemote workWeekend workAfternoon shift
Miami Jewish Health
Miami, FL1 day ago $26.41 - $61.79 per hour
...clinical member services review assessment processes.... ...integrated delivery of care across the continuum. Contributes... ...reviews to determine prior authorization/financial... ...care model. Adheres to utilization management (UM)... ...experience. Registered Nurse (RN) with an active and...SuggestedHourly payWork experience placementWork at office$75.34k - $100.2k
...outpatient centers, urgent care facilities and physician... ..., retrospective chart review for clinical financial resource utilization. Coordinates with healthcare... ...: RNs hired prior to 2-2012 (10/1/2017 at Bethesda... ...non-leadership role as an RN. however, they are required...SuggestedLocal areaBaptist Health South Florida
Miami, FL3 days ago- Florida PACE Centers, Inc. is seeking a Utilization RN to conduct prospective, concurrent, and retrospective reviews ensuring medical necessity and appropriate level of care across the continuum. The role collaborates with hospital UR/Case Management, IDT, and community...SuggestedRemote job
$28 per hour
LPN Utilization Management Nurse Reviewer Miami, FL (Work from Home position for FL residents only) Currently... ...utilization for members receiving Home Health Care / Infusion Services and Durable... ...for DME: 1 year (Required) prior authorization UM review: 1 year (Required...SuggestedHourly payFull timeWork at officeLocal areaRemote workWork from homeRelocationHome officeWeekday work- ...appropriateness of continued stay utilizing the Interqual Criteria... ...of resources of all patients reviewed. Working with clients, family... ...friend support networks and health care professionals to put care plans... ...Certifications: Current Florida RN Licensure BLS Certification....Full timeWork experience placementDay shift
Palmetto General Hospital
Hialeah, FL13 days ago - ...Management (MTM) Clinician is responsible for... ...Comprehensive Medication Reviews, Targeted... ...and Transitions in Care. Conduct proactive... ...medication utilization. Identify adherence... ...Florida Registered (RN, LPN, NP) Requires... ...three (3) years prior experience working...Full timeWork at office
- Coastal Care Services, Inc. is seeking an LPN licensed Utilization Management Nurse Reviewer for a work-from-home opportunity serving the Miami, FL area. Work schedule is 10am to 7pm, with every other Sunday and a weekday off for a total of five days per week. The role...Remote jobWeekday work
- ...site and/or telephonic concurrent reviews and discharge planning and... ...skilled nursing admission, home care, home care infusion services, outpatient... ...PCP appointments for members prior to discharge Collaborates with... ...and unrestricted Florida RN license. Case management and health...Private practiceWork at office
- ...individual to support facility reviews and discharge planning in Miami,... ...service authorizations, facilitating care transitions, and ensuring... ...candidate will have a current Florida RN license and 3 years of experience in case management or prior authorization. Familiarity with...
- ...Title: Medical Management Clinician Senior (RN) Job Description:... ...is a local Medicare Managed Care Organization with administrative... ...administration of plan benefits by reviewing clinical information and... ...and effectiveness of the utilization reviews within the medical...Full timeContract workTemporary workWork at officeLocal areaMonday to FridayShift work1 day per week
- ...leading provider of end-of-life care. We provide our employees with... ...Care Registered Nurse (RN) supports VITAS Healthcare's growing... ...recovery after treatment utilizing appropriate resources as needed... ...Builds relationships with other clinicians involved in the patients' care...Full timeFlexible hours
VITAS Healthcare
Miami, FL2 days ago - ...RN 12 HOUR SHIFT- IMMEDIATE HIRE Under the direction... ...delivery of nursing care and nursing staff performance... ...emotional status · Review the nurse's notes to... ...the resident's care plan prior to administering care to... ...areas daily, such as clean utility room, to ensure that...Immediate startTrial periodAll shiftsShift work
Citadel Care Centers
Miami, FL4 days ago - Coral West Community Hospital seeks an RN Care Manager to lead utilization review and discharge planning for an assigned caseload. The role requires collaborating with physicians, social workers, and payers to ensure appropriate care and reimbursement. The candidate will...
- ...MDS Coordinator - RN A skilled nursing facility is looking... ...the Minimum Data Set (MDS), Care Area Assessments (CAA's) and... ...timely and accurate completion of Utilization Review and Triple Check. Serves... ...a long term care setting Prior experience as an MDS...
HC&N Healthcare Solutions
Miami, FL23 hours ago - ...perform initial, concurrent, and retrospective chart reviews to support clinical financial resource utilization. The role involves coordination with the healthcare... ...stay and avoiding delays in reimbursement. Requires RN licensure, familiarity with MCG guidelines, and may...
- ...supervises individual patient care on a nursing unit... ...assessment of the patient, utilizing the knowledge of age specific... ...sedation/anesthesia history, reviews patient’s medical records, prior medications administered,... ...Minimum Job Requirements RN - Registered Nurse RN...Full timeWork at office
- ...the planning and delivery of care utilizing nursing processes: assessment... ...dates of implants are checked prior to use of any implant during... ...with patients and families to review plan of care, solicits input,... ...Registered Nurse RN Licensure within the State of...Full timeImmediate start
- ...the planning and delivery of care utilizing nursing processes: assessment... ...Conducts handoff with oncoming RN utilizing SBAR; documents in... ...30 minutes and documents a clinician notification in Cerner. Completes... ...patients and families to review plan of care and solicits input...Full time
$38 - $44 per hour
...Actalent is Hiring an RN Case Manager // Must Have... ...comprehensive care for maternal and child... ...appointments. Coordinate utilization management activities,... ...and resources to help clinicians succeed in a high-impact... ...that your application may be reviewed using AI tools....Contract workTemporary workCasual workWork at officeRemote workMonday to FridayFlexible hoursActalent
Miami, FL3 days ago- ...the planning and delivery of care utilizing nursing processes: assessment... ...Qualifications Minimum Job Requirements RN licensure within the State of... ...medical history 48 hours prior to appointment to minimize... ...patients and families to review plan of care and solicits...Daily paidImmediate startShift work
- ...Registered Nurse Field plans and delivers care to patients in their place of residence utilizing the nursing process of assessment... ...that consistently is updated and reviewed to reflect assessment findings to... ...plan development and implements prior to discharge of the patient....Interim roleWork at officeLocal area
- ...Responsible for the planning and delivery of care utilizing nursing processes, assessment,... ...Communicates with patients and families to review plan of care and solicits input and communicate... ...Minimum Job Requirements RN - Registered Nurse RN Licensure within the...Full timeShift workNight shift
Nicklaus Children's Health System
Miami, FL1 day ago - ...Responsible for the planning and delivery of care utilizing nursing processes: assessment,... ...Communicates with patients and families to review plan of care and solicits input and communicates... ...Job Requirements Registered Nurse RN Licensure within the State of Florida or...Full timeShift work
Nicklaus Children's Health System
Miami, FL3 days ago - Nicklaushealth is seeking an RN Professional Practice Quality Reviewer to oversee OPPE and FPPE, ensuring regulatory compliance and supporting credentialing to promote high-quality patient care. You will collaborate with medical staff, hospital leadership, and quality...
- ...cases that require medical necessity review such as home care, elective inpatient and outpatient service... .... Reviews cases referred by the prior-authorization non-clinical medical... ...care while advocating for appropriate utilization of health system resources consistent...Contract workWork at office
- Job Summary The RN Professional Practice Quality Reviewer is responsible for overseeing the Ongoing Professional Practice Evaluation (OPPE) and Focused... ...supports credentialing, and promotes high-quality patient care. Collaborates with medical staff, hospital leadership,...Full timeWork at office
- ...or staff position, please review this tip sheet ( . The... ...patient-family centered care in a culturally competent manner utilizing evidence-based standards... ...requiredValid State of Florida RN license requiredRefer to... ...surgical booking sheets prior to surgery at the...Full timeTemporary workWork at officeWorldwide
University of Miami
Miami, FL3 days ago - ...the highest degree of quality care is always maintained. Responsibilities... ...and emotional status · Reviewing the nurse's notes to ensure... ...to the resident's care plan prior to administering care to the... ...treatment areas daily, such as clean utility room, to ensure that they are...Local areaImmediate startTrial periodAll shiftsShift work
Jackson Gardens Health & Rehabilitation Center
Miami, FL4 days ago $77.2k - $106.2k
...Join Our Caring Community A Registered Nurse administers skilled nursing care to patients... ...defined time frames. Appropriately utilizes ICD-10 codes. Other Duties A Registered... ...to his/her care. Participates in peer review and Quality Assurance and Performance Improvement...Daily paidLocal areaNight shiftWeekend workHumana
Miami, FL4 days ago
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to RN Care Review Clinician - Utilization & Prior Auth. Be the first to apply!
