Care Review RN: Utilization & Care Coordination (FL)
$26.41 - $51.49 per hourMolina Healthcare of Illinois
Molina Healthcare in California, MO is seeking a Clinical Member Services Reviewer. The role includes assessing clinical service requests, ensuring compliance with regulations, and collaborating with teams for healthcare delivery. The ideal candidate has an active RN license and at least 2 years of experience in hospital or managed care settings. Competitive pay is offered, ranging from $26.41 to $51.49 hourly based on experience and skills. #J-18808-Ljbffr Molina Healthcare
- ...healthcare organization is seeking a skilled professional to provide utilization review and coordinate care for members in California. The successful candidate will have a Nursing school degree and a California RN License. Key responsibilities include ensuring quality and...Suggested
- ...Description Responsible for providing utilization review and coordination of care throughout the healthcare continuum to promote quality and cost effective care to the members. Qualifications Nursing school graduate. California Registered Nurse License upon hire. 3 years...SuggestedWork at office
$74.29k - $111.43k
...Job Summary The Concurrent Utilization Review (UR) Nurse is responsible for... ...to members under a managed care health plan. The role involves... ...and continued stays, coordinating with healthcare providers, facilitating... ...– Registered Nurse (RN) with an active, unrestricted...SuggestedWork at office$26.41 - $51.49 per hour
...for clinical member services review assessment processes. Responsible... ...integrated delivery of care across the continuum. Contributes... ...Molina care model. Adheres to utilization management (UM) policies and... ...experience. Registered Nurse (RN). License must be active and...SuggestedHourly payWork experience placementWork at officeRemote work$74.29k - $111.43k
NeueHealth in California is seeking a Concurrent Utilization Review Nurse responsible for conducting clinical reviews to ensure the medical necessity... ...and appropriateness of services provided under a managed care plan. The role requires 2-3 years of clinical experience,...Suggested- ...The RN Utilization Management (RN UM) functions as a support liaison for a variety of UM functions... ...management, and the UM process. Coordinates care submission relating to the process of... ...extended hospital stays, and discharge review that determine medical necessity. The...Full timeLocal area
$160k
Care Coordination Case Management Nurse — Southern California Hospital Opportunity The Care Coordination... ...nurses, physicians, social workers, utilization review specialists, and a diverse team of... ...explore this hospital case management RN opportunity—spark the next step in an...$30 - $34 per hour
...Overview Utilization Review Nurse - Remote at Astrana Health Location: 600 City Parkway West 10th Floor, Orange, CA 92868 Compensation... ...Put Patients First Empower Entrepreneurial Provider and Care Teams Operate with Integrity & Excellence Be Innovative...Hourly payRemote workMonday to Friday$55 per hour
...Akkodis is hiring a Concurrent Review Nurse to support our client in... ...for ensuring that member care is provided at the most appropriate... ...in case management, utilization management, or discharge planning... ...judgment within the scope of RN practice in California. Ability...Full timeContract workTemporary workLocal areaRemote work$30.37 - $59.21 per hour
Molina Healthcare in California seeks a Clinical Reviewer to support member service assessments and ensure services align... ..., and collaborating with teams to optimize member care. The ideal candidate holds an active RN license and brings at least 2 years of experience. Molina...Hourly pay$27.61 - $53.83 per hour
...includes assessing services to ensure compliance with regulations and optimizing member outcomes through effective collaboration and review processes. Candidates should have at least 2 years of relevant healthcare experience, strong communication skills, and proficiency...Hourly payWork at office- ...Description Summary:**The RN Case Manager, in... ...interdisciplinary plan of care for patients, determining... ...and retrospective case review. This position... ...Substantial recent experience in utilization review and/or discharge... ...Modifiable)****Care Coordination*** Works with the healthcare...Daily paidShift work
$30 - $34 per hour
A healthcare services company is seeking an experienced Utilization Review Nurse to work remotely. The ideal candidate must hold an active LVN license in California and have experience in outpatient utilization management. Responsibilities include approving or denying...Hourly payRemote work$27.61 - $53.83 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....Hourly payContract workWork experience placementWork at office$26.35 - $39.53 per hour
...consumers are entitled to high-quality, coordinated care. By uniquely aligning the interests of... ...for all. Job Summary The Concurrent Utilization Review (UR) Nurse is responsible for conducting... ...Education: Registered Nurse (RN) or Licensed Vocational/Practical Nurse...Hourly payWork at officeRemote work$75.3k - $135.4k
...Prior Authorization, Concurrent Review, and/or Retrospective Review Clinical... ...team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. Monitors and tracks... .... License/Certification RN - Registered Nurse - State Licensure...Full timePart timeWork at officeRemote workFlexible hours- ...Centene Corp. is seeking a Supervisor, Utilization Management (RN) to lead and supervise our Clinical Review team. This role focuses on ensuring appropriate care for our members and promotes adherence to compliance standards through effective team management and continuous...Remote workFlexible hours
- ...Ocean State Job Lot is seeking a Registered Nurse for Utilization Management in California. The RN UM will support various UM functions including care coordination, denials management, and insurance authorization processes. Candidates must have an Associate Degree in Nursing...
$26.35 - $39.53 per hour
Job Summary The Concurrent Utilization Review (UR) Nurse is responsible for... ...to members under a managed care health plan. This role involves... ...and continued stays, coordinating with healthcare providers, facilitating... ...: Registered Nurse (RN) or Licensed Vocational/Practical...Hourly payWork at office- ...RN Clinical Staff Nurse - EmPATH - Full Time Nights... ...management of patient care. Reporting to the... ..., planning, directing, coordinating, and providing high quality... ...problem‑solving model; utilizing knowledge and experience... ...positive patient outcomes. Reviews all orders on patients,...Hourly payFull timeLocal areaShift workNight shift
$34 - $36 per hour
...services in our recuperative care centers, emergency shelters,... ...Job Description The Medical Coordinator (LVN) is responsible for delivering... ...with patient’s providers and reviewing medication list Establish and... ...forms upon admission Utilize infection control measures according...Hourly payWork at officeNight shiftDay shiftAfternoon shift- RN Clinical Coordinator RMG page is loaded## RN Clinical Coordinator RMGlocations: Riverside Shore Memorial... ..., productivity and regular chart reviews. **What you will do** * Ensure... ...a high level of accuracy of clinical care to patients from our physicians and clinical...Work at officeFlexible hours
- ...of Orange County is seeking a dedicated RN Care Manager for their Primary Care team in... ...California. The role involves delivering care coordination for pediatric patients, overseeing care... ...teams, and ensuring effective resource utilization for optimal health outcomes. The ideal...
- ...Executive Service Corps is seeking an RN Case Manager-Pre Access in... ...screening and facilitating admission reviews for acute patients. The ideal candidate... ..., and has experience in an acute care setting. Responsibilities include coordinating patient transfers and ensuring...
- RN.com is seeking a dedicated RN Case Manager in California to facilitate discharge planning and perform utilization reviews. The ideal candidate should hold a valid CA RN license and a BSN, with substantial experience in acute care settings. Responsibilities include working...Immediate start
$74.56 - $90.51 per hour
Job Summary and Responsibilities Day Full Time RN Care Coordinator The RN Care Coordinator is responsible for overseeing the progression... ...on care coordination communication and collaboration with utilization management nursing physicians, ancillary departments, insurers...Hourly payFull time$50.4 - $70 per hour
...Pacific Cancer Care has provided superior care for... ...direction of the Charge RN and the Director of Clinical... ...be responsible for the coordination and delivery of quality... ...devices.Recognizes and reviews appropriate lab tests/... ...of cytotoxic agents. Utilizes appropriate personal...Hourly payFull timeWork at officeMonday to FridayShift work- ...opening Registered Nurse (RN) Plans and provides comprehensive nursing care including, but not... ...treatment orders. Assist in coordinating professional medical services... ...provider agencies. Utilize established corporate, facility... ...Administrator with the review of medical files to...Contract workRotating shift
$44.42 - $61.2 per hour
...Position Summary Registered Nurse (RN) – Care Management – hybrid remote... ...reconciliation, adherence; coordinate with providers and... ...members; participate in case reviews, huddles, and interdisciplinary... ...for avoidable hospital or ED utilization, adults at risk of LTC institutionalization...Hourly payLocal areaRemote work- RN Quality Assurance Coordinator - CalAIM The Quality Assurance Coordinator supports quality improvement efforts by managing how performance data is collected, reviewed, and shared within a correctional health care setting. The role focuses on monitoring compliance and...
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