Florida Care Review Clinician - Utilization & Outcomes
$24 - $46.81 per hourMolina Healthcare of Illinois
Molina Healthcare is seeking a healthcare professional for a support role in clinical member services. The position involves verifying service necessity according to established guidelines, ensuring cost-effectiveness and compliance with regulations to achieve desired outcomes for members. Candidates must have at least 2 years of relevant healthcare experience, clinical licensure when mandated, and strong communication skills. The role offers a pay range of $24 - $46.81 per hour, depending on experience and location. #J-18808-Ljbffr Molina Healthcare
$73.86k - $96.02k
...concurrent, retrospective chart review for clinical financial resource utilization. Coordinates with the... ...and efficient patient outcomes, while decreasing length... ...& Certifications: MCG Care Guidelines Specialist.... ...: 3 Years. #J-18808-Ljbffr Baptist Health South FloridaSuggestedLocal area$73.86k - $96.02k
Baptist Health South Florida is seeking a qualified individual to conduct chart reviews for clinical financial resource utilization. The role requires effective communication with healthcare... ...various agencies to optimize patient outcomes. Qualifications include at least an...Suggested$26.41 - $51.49 per hour
...Overview Must reside in Florida Job Summary: Provides support... ...member services review assessment processes. Responsible... ...members reach desired outcomes through integrated delivery of care across the continuum.... ...care model. Adheres to utilization management (UM) policies...SuggestedHourly payWork experience placementWork at officeRemote work$26.41 - $51.49 per hour
Must live in Florida. Job Summary Provides support for member clinical review processes specific to applied behavioral... ...members reach desired outcomes through integrated delivery of care across the continuum.... ...collaboratively with the utilization and care management...SuggestedHourly payWork experience placementLive inWork at officeLocal area- ...DO with at least 6 years of clinical experience and 1 year in utilization review. Responsibilities include timely medical reviews, clinical determinations, and accurate documentation. Licensure in Florida or North Carolina is a must, with a preference for multiple state...SuggestedFull time
- Itlearn360 is seeking a dedicated Utilization Management professional based in the Town of Florida, New York. The role requires... ...Management. Responsibilities include reviewing patient clinical information,... ...focused on teamwork and patient care. #J-18808-Ljbffr Itlearn360Full time
- ...About Orlando Health - Florida Heart and Vascular: Orlando... ...surgery and primary care. With practice... ...Essential Functions: Utilize the unique knowledge, skills... ...practice and organizational outcomes. Participates and may... ...and organizational peer review, mentoring, and...Local area
- ...focused on member‑centered care. Founded in 2012, it... ...pharmacy services by reviewing clinical information... ...information and explain review outcomes, including alternative... ...Medical Director, Utilization Management.... ...MD or DO. Licensed in Florida or North Carolina, and...Remote jobWeekend work
$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...Hourly pay- A healthcare services company is seeking a Clinical Care Reviewer based in Doral, FL. The role requires a current FL RN licensure and a... ...settings such as ER or ICU. Candidates should have experience with Utilization Review, familiarity with Interqual Criterion, and good...
$26.41 - $51.49 per hour
...professional to provide support in clinical service reviews. The role involves assessing compliance... ...member services, ensuring high-quality care. Applicants must hold appropriate... ...settings. The position is based in the Town of Florida, New York, with a competitive pay range...Hourly pay$26.41 - $51.49 per hour
...professionals to provide support for member clinical service review processes in California. The role involves ensuring that services... ...align with clinical guidelines and that members reach desired care outcomes. Candidates should have at least two years of health care...Hourly pay- ...Summary: Administers patient care in an area where... ...Responsibilities Essential Functions: Utilize the unique knowledge,... ...and organizational outcomes. Participate and may... ...organizational peer review, mentoring, and... ...nurse in the State of Florida or Nurse Licensure Compact...Local area
- ...Eye Institute Palm Beach Gardens, Florida page is loaded## Registered Nurse... ...faculty or staff position, please review this .The University of Miami, Bascom... ...delivers patient-family centered care in a culturally competent manner utilizing evidence-based standards of...Full timeTemporary workWorldwide
$62.7k - $100.4k
A healthcare organization is seeking a Clinical Care Reviewer II responsible for processing medical necessity reviews and assisting with care coordination activities. Candidates need to hold an Associate's degree in nursing and have at least three years of clinical experience...- ...met with barriers to care. From limited local options... ...—between clients and clinicians, care teams, loved... ...care and driving better outcomes from the comfort of... ...mental health diagnoses utilizing DSM‑V criteria Document... ...Benefits, Utilization Review, and Clinical teams in...Remote jobFull timeLocal areaShift workWeekend workDay shiftAfternoon shift
$68.13k - $119.52k
...City: ALTAMONTE SPRINGS State: Florida Postal Code: 32714 Job... ...continued stay medical necessity reviews. Maintain thorough knowledge... ...with the multidisciplinary care team regarding patient status... ...authorizations for in-house patients, utilizing daily commercial...Full timeWork experience placementLocal areaShift work- ...healthcare staffing firm is seeking a Registered Nurse for Concurrent Review in Florida. The role involves telephonic review of inpatient admissions to ensure appropriate medical necessity and care levels. Candidates must have an active RN license in Florida and 2+ years...Full timeWork at officeMonday to Friday
- ...company has published more than 20 peer‑reviewed studies, and delivered unmatched outcomes in terms of access, clinical... ...research confirms Lyra’s transformative care model helps people recover twice... ...stage. Evidence‑Based Treatment – Utilize proven therapeutic techniques and...Full timeContract work
- ...Nocturnist needed in Palm Beach, Florida!! We believe in providing... ..., efficient, and high‑quality care to our patients. We're looking... ...patient care plans. Diagnostic Review: Interpret and integrate data... ...plans, medical decisions, and outcomes in the Electronic Health Records...Immediate startShift workNight shift
- LanceSoft, Inc. is seeking a travel nurse RN for Acute Care Case Management in Ft. Walton Bch, Florida. The role requires acute hospital Case Management... .... Ideal candidates will be comfortable with utilization review, discharge planning, and hospital case coordination...Weekly payDay shift
- ...join our growing team of expert clinical reviewers. In this role, you will apply your expertise... ...our clients related to vascular surgery care. Join a team that values your clinical... ...in vascular surgery Current, unrestricted Florida medical license Minimum of 5+ years of clinical...For contractorsRemote work
- Overview Become a part of our caring community The Clinical Care... ...focused on improving patient outcomes. You will support safe Transitions... ...(TOC), reduce avoidable ED utilization, and drive Medicare Advantage... ...in the following areas: Florida - Palm Beach Gardens, University...
- TurningPoint Healthcare Solutions is hiring a Supervisor, Clinical Review Nurse in New York. This full-time role involves overseeing Utilization Management activities and leading a clinical team. Candidates should possess an active RN license, a minimum of five years of...Full time
$26.41 - $51.49 per hour
...Healthcare is seeking a Behavioral Analyst to support member clinical review processes for ABA services. The role involves assessing compliance, analyzing clinical requests, and collaborating with care management departments to provide quality care to members with autism...Hourly pay$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-end... ...claims against industry standards, utilizing research of relevant ICD‐10, CPT, and HCPCS...Contract workWork at officeLocal areaImmediate startRemote work$37 - $38 per hour
...planning and delivery of patient care, providing skilled nursing... ...Hospice policies and the Florida Nurse Practice Act, utilizing the nursing process of... ...based on competency review, chart audits and direct oversight... ..., interventions and outcomes and address progress towards...Hourly payLocal areaNight shift- ...join our growing team of expert clinical reviewers. In this role, you will apply your expertise... ...our clients related to vascular surgery care. Join a team that values your clinical... ...vascular surgery Current, unrestricted Florida medical license Minimum of 5+ years of clinical...For contractorsRemote work
- ...provide expert patient care across diverse clinical... ...comfort, and optimal health outcomes. Your expertise will... ..., and medical history reviews to determine individual... ...and safety protocols. Utilize EMR (Electronic Medical... ...with the state of Florida. Proven experience in...Full timeFlexible hours
- Integrated Home Care Services, Inc. is seeking a Utilization Management Nurse in Florida, NY. You will ensure home health care services are delivered efficiently and within compliance, reviewing patient treatment files and certifying medical necessities. Key qualifications...
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