Care Review Clinician - Utilization & Care Coordination FL
Molina Healthcare
Molina Healthcare is seeking a clinical reviewer to support member services in assessing specialty care requests. The role ensures services are medically necessary, aligned with guidelines and policies, and that members achieve outcomes through integrated care. The position requires residing in Florida and contributing to cost-effective care strategies. Responsibilities include reviewing requests, determining benefits and eligibility, and coordinating with medical directors and teams to uphold #J-18808-Ljbffr Molina Healthcare
$26.41 - $51.49 per hour
...Healthcare in California, MO is seeking a Clinical Member Services Reviewer. The role includes assessing clinical service requests, ensuring... ...and at least 2 years of experience in hospital or managed care settings. Competitive pay is offered, ranging from $26.41 to $51...SuggestedHourly pay- ...management guidelines. Candidates should have strong experience in utilization review or case management and excellent communication skills. This position requires the ability to analyze data and coordinate care effectively within a multidisciplinary team. #J-18808-Ljbffr...Suggested
- Molina Healthcare is seeking an RN to support clinical member services review assessment processes in New York. You will verify medical necessity and alignment with guidelines, coordinating care across the continuum to reach desired outcomes. Responsibilities include prior...Suggested
- ...seeking a qualified clinical nurse for a utilization management role. Candidates should... ...utilization management within a managed care environment. The position requires collaboration... ...to ensure quality care and involves reviewing medical necessity. Applicants can reach...Suggested
$26.41 - $51.49 per hour
...Provides support for clinical member services review assessment processes. Responsible for... ...outcomes through integrated delivery of care across the continuum. Contributes to overarching... ...the Molina care model. Adheres to utilization management (UM) policies and procedures....SuggestedRemote jobHourly payWork experience placementWork at office- ...are seeking a highly motivated and experienced Utilization Review Nurse to join our team. The Utilization Review Nurse... ...to ensure patients are receiving appropriate care at the correct level of service. Care Coordination: Collaborate with interdisciplinary healthcare teams...Work experience placement
- ...Business Solutions LLC seeks an experienced Utilization Review Nurse in New York to provide clinical guidance, drive appropriate level of care, and support revenue cycle efficiency.... ...conduct medical record assessments, coordinate care with interdisciplinary teams, apply...
- A healthcare services company is seeking a Clinical Care Reviewer based in Doral, FL. The role requires a current FL RN licensure and a minimum of... ...as ER or ICU. Candidates should have experience with Utilization Review, familiarity with Interqual Criterion, and good knowledge...
$70.95k - $106.42k
## Utilization Management Clinician (Tuesday - Saturday)Applylocations: WFH: FLtime type... ...quality, affordable care!***PacificSource is an equal... ...-medical professionals to coordinate delivery of healthcare services... ....* Perform concurrent review of members admitted to inpatient...Contract workWork experience placementWork at officeWork from home- ...the highest quality in-home care services that improve and enhance... ...What Will You Be Doing As a Utilization Management Nurse, you will... ...compliance. By continuously reviewing and auditing patient... ...requests for medical necessity Coordinates patient care needs with a multi...Full timeTemporary work
- ...Center in New York is seeking a Concurrent Review Nurse to ensure medically necessary, high-quality, and cost-effective care through inpatient and outpatient care reviews... ...policies. You will lead clinical review processes, coordinate with providers, and document determinations...
$40 per hour
Nurse Reviewer PT (20‑30 hours week) - Remote Work Environment Non‑Exempt: $40.00 hour Supports... ...compliance with established standards of care and applicable policies Manage end-to-... ...claims against industry standards, utilizing research of relevant ICD‑10, CPT, and HCPCS...Contract workWork at officeLocal areaImmediate startRemote work$90k - $125k
...Legal Address - JUPITER, FL 33458 Position Type:... ...Negligible Job Category: Health Care Job Summary The RN... ...Liaison manages and coordinates patient care within the... ...connection and show value. Review EMR and/or care... ...Work support as needed. Utilize, interpret and deliver...Full timeWork at office- ...practice providers and specialty clinicians committed to delivering high-quality, proactive care directly to residents in... ...Practical Nurse to assist with reviewing patient's charts. You will review... ...of care and appropriate utilization of resources Monitor and evaluate...
- Jobtailor in New York seeks an experienced nurse (RN/LPN) to lead utilization reviews and support clinicians. You will apply medical policies, mentor staff, and collaborate with leadership on process improvements to enhance health outcomes. The role requires 6+ years of...
$30 - $35 per hour
...providers and specialty clinicians committed to... ...quality, proactive care directly to... ...Location: Hollywood, FL (In-Office) Schedule... ...as a Nursing Care Coordinator. Operating strategically... ...role, you will review and verify chart... ...verticals. Systems Utilization : Maintain...Hourly payFull timeWork at officeRelocation packageMonday to Friday- ...healthcare services. Involves coordinating with healthcare providers to maintain compliance with utilization management guidelines and... ...plans for effective patient care and resource utilization. Requires... ...(3) years of utilization review, case management, or third-party...
- ...and cost effectiveness of medical care by applying clinical acumen and... ...emergent/urgent and continued stay reviews. Perform onsite review of... ...electronically, telephonically, or onsite to coordinate member care Educate providers on utilization and medical management processes...Shift work
- ...Health Services, the Concurrent Review Nurse is responsible for... ...-quality, and cost-effective care. This is achieved through the... ...the healthcare continuum by coordinating with facilities and the Care... ...experience in clinical review or utilization management Language Skills...
- First Coast Service Options is seeking a Clinical Review Nurse to evaluate medical necessity, coverage, and payment levels for Medicare... ...applies clinical knowledge to determine the appropriateness of care in line with CMS policies and standards. The incumbent will review...Remote job
- ...PRIMARY PURPOSE: To support utilization management, quality improvement... ...-centered, cost-effective care while ensuring compliance with... ...FoundCare. 1. Quality Improvement Coordinate and participate in the... ...2. Utilization Management Review utilization data to identify...Work at office
- ...seeking a licensed registered nurse to perform preauthorization reviews for diagnostic imaging, focusing on medical necessity and... ...familiarity with UM guidelines, ICD-10/CPT-4 coding, and experience in utilization or quality management or call centers. On-site work is...
$26.41 - $51.49 per hour
...Summary Provides support for member services review assessment activities for a specific area... ...outcomes through integrated delivery of care across the continuum. Contributes to... ...Molina care model. Adheres to applicable utilization management policies and procedures. Required...Remote jobHourly payWork experience placementWork at office- TurningPoint Healthcare Solutions is hiring a Utilization Review Nurse to work remotely. The ideal candidate must hold a valid LPN or RN license and possess strong critical thinking and clinical expertise. Responsibilities include performing initial clinical reviews, assisting...Remote job
- AdventHealth in Zephyrhills, FL is seeking an experienced RN to join our discharge planning... ...participate in multidisciplinary rounds to review patient status, coordinate discharge plans, and ensure timely transitions of care for diverse patient populations. You will educate...
- IHCS seeks a Utilization Management Nurse to ensure home health services are delivered with quality, cost efficiency, and compliance. You will review patient treatment files, perform concurrent reviews, and coordinate care with a multidisciplinary team. State licensure...
- ...Wellington Physicians Urgent Care and other healthcare services... ...outpatient services. Quality Coordinator/RN Responsible for the implementation... ...Center | Palm Beach Gardens, FL Benefit Highlights... ...anagement. Knowledge of peer review and clinical chart reviews. Knowledge...Work at officeLocal area
- ...platform focused on member‑centered care. Founded in 2012, it delivers... ..., and pharmacy services by reviewing clinical information and... ...the Associate Medical Director, Utilization Management. Requirements Board... ...setting. License Must Have FL License NC License IMLC Preferred...Remote jobWeekend work
- ChenMed is seeking a Licensed Physician Reviewer in Obstetrics & Gynecology for remote PRN coverage. The physician will lead delegated utilization management (UM) reviews, coordinate with health plan teams and local staff, and participate in quality improvement initiatives...Remote jobReliefLocal area
- About This Role As an RN Care Coordinator in Orthopaedic Surgery at Cleveland Clinic Weston Hospital... .... Highlights Location: Weston, FL Facility: Cleveland Clinic Weston Hospital... ...coordination needs and conduct targeted outreach. Utilize assessment skills and risk assessment...Full timeDay shift
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