Impactful RN: Case Management & Utilization Review
Baptist Health
Baptist Health is seeking a Registered Nurse to perform initial, concurrent, and retrospective chart reviews to support clinical, financial and utilization outcomes. You will collaborate with care teams to optimize patient flow and reduce delays, while addressing payer issues and ensuring timely reimbursement. The role requires strong communication, negotiation skills and hospital experience, with attention to regulatory compliance and efficient data management. #J-18808-Ljbffr Baptist Health
$47 per hour
...part in making a positive impact - because when it comes... ..., retrospective chart review for clinical, financial and resource utilization. Coordinates with healthcare... ...-leadership role as an RN; however, required to... ...Strong analytical, data management and computer skills. Strong...SuggestedDaily paidLocal areaShift workWeekend work- Uloop Inc. is seeking a Utilization Management professional to review medical necessity for home care and elective services, ensuring alignment with plan... ...have 2+ years in pre-authorization, utilization review, case management, and discharge planning, with strong...Suggested
$26.41 - $61.79 per hour
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...SuggestedHourly pay$33 - $39 per hour
...Registered Nurse, RN The Registered Nurse, RN, is a member... ...Job Responsibilities Case Management and Supervision for Registered... ...Appropriately identifies/utilizes resources, referrals such as... ...personally and per Team Manager reviews Responsible for attending...SuggestedShift workNight shiftRotating shiftWeekend workAfternoon shift$26.41 - $61.79 per hour
...for clinical member services review assessment processes.... ...timelines. Refers appropriate cases to medical directors (MDs) and... ...Molina care model. Adheres to utilization management (UM) policies and procedures... ...experience. Registered Nurse (RN) with an active and...SuggestedHourly payWork experience placementWork at office- ...facilitate services on patient management and leads in the... ...with clinic staff, case management, and authorizations... ...following medical review. Arranges support groups... ...therapy. Utilizes Lean methodology to improve... ...Minimum Job Requirements ~ RN Licensure within the...Full timeWork at office
$24.03 per hour
...with opioid use disorder manage cravings, reduce... ...mental health counseling, case management, risk reduction... ...treatment/medical care utilizing MD when appropriate... ...with treatment plans/case reviews and implementing all features... ...to evaluate the impact of substance use, mental...Hourly payFull timeReliefWork at officeShift work1 day per week$31.77 - $41.78 per hour
...Health Registered Nurse (RN) Miami, FL, US 3 days... ..., chronic disease management, preventive health services... ...health education, and case management. The RN serves... ...Promote awareness and utilization of school-based health... ...documentation audits, chart reviews, and performance...Hourly pay- ...position using the Career worklet, please review this tip sheet.Case Manager RNThe UHealth System at the... ...exciting opportunity for a Case Manager RN in the Population Health Department.... ...care to assure appropriate utilization of resources while maintaining quality...Temporary workWork at officeRemote workWorldwide
- ...MCG screening criteria. Responsibilities Manages appropriate cases that require medical necessity review such as home care, elective inpatient and outpatient... ...quality care while advocating for appropriate utilization of health system resources consistent with...Contract workWork at office
- Molina Healthcare in Florida is seeking a clinical reviewer to support ABA/BHT services, ensuring medical necessity and alignment... ...involves reviewing ABA requests, collaborating with utilization and care management, and supporting training and provider consultations while...
- ...Utilization Review Case Manager The University of Miami Health System Department of UMHC SCCC Business Operations has an exciting opportunity for a full time Utilization Review Case Manager to work to work remote. The incumbent conducts initial, concurrent and retrospective...Remote jobFull timeWork experience placement
- ...Job Description Job Description The RN Medical Care Manager (MCM) blends the mission of AHF with Medical Case Management, utilizing their experience, skills and education together... ...Fight for What's Right Please review our Advocacy page for the latest news on...Contract workWork at officeRelocationRelocation packageShift work
- University of Miami is seeking an Oncology Prior Authorization Case Manager, Non-RN, to work remotely with a focus on efficient utilization review and patient care coordination. The role involves chart reviews, payer policy application, and seamless communication with clinical...Remote job
$35 - $36 per hour
...benefits Collaborate with physicians, case managers, and interdisciplinary teams Provide... ...We're Looking For Registered Nurse (RN) with a valid state license Minimum... ...time. A Balanced Pace, A Powerful Impact Make a meaningful difference...Flexible hoursNight shiftWeekend workDay shiftWeekday work- ...staff position, please review this tip sheet ( . CORE... ...competent manner utilizing evidence-based standards... ...Valid State of Florida RN license requiredRefer to... ...patient with e-check-in Managing the clinic schedule (... ...to transform and impact the lives of its students...Full timeTemporary workCasual workWork at officeWorldwideMonday to FridayDay shift
- ...this role supports the clinic manager daily, assuming... ...clinical and technical issues. • Review and verify completion of required... ...operating procedures. • Promotes utilization of CQI principles to increase... ...Duties: • In some cases, may be required to function...Work at officeShift work
- ...Nurse Case ManagerBattelle delivers when others can't. We conduct... ...research and development, manage national laboratories,... ...Manager, you will contribute to impactful research and analytics that... ...skill in using pre-established utilization review criteria to recognize and...Full timeWork at officeLocal areaRemote workFlexible hours
$53.16k
...functioning and well being. Utilizes understanding of human behavior... ...: Works with student truancy cases as determined by School Board... ...attendance. 5. Case Management: Coordinates access to community... ...knowledge through research, review of literature, participation...Local area$144k
...be limited to: Performs case finding functions and... ...risk patients and provides case management services. Establishes and... ...medical and social problems utilizing individual, group and family... ...psychosocial needs of Veterans and the impact of psychosocial problems on...Permanent employmentFull timePart timeRemote work- ...Registered Nurse Case Manager As the nation's largest private employer... ...You Will Need: RN with current state licensure... ...Certification in case management or utilization review preferred InterQual... ...leverages our size to make a real impact in our industry! Our Talent...Temporary workFlexible hours
- ...Senior Hospitalist Clinical Reviewer Job Type: Contractor Location... ...Reviewers to support a high-impact project focused on inpatient... ...to evaluate inpatient cases, identify complex or ambiguous... ...Experience with medical coding, utilization review, or physician audit...Remote jobFor contractors
- ...Concurrent Review Nurse Under the general supervision of the... ...evidence-based guidelines, and managed care standards. Essential... ...applicable. Refer complex cases to a Medical Director or Behavioral... ...in clinical review or utilization management Language Skills...
- ...RN Health Coach RN Health Coach is a purposeful, result oriented... ...focuses on disease process management and education intended to... ...s condition Participate in case conferences, team meetings, staff... ...Prepares clients' discharge by reviewing and amplifying discharge plans...Local areaRemote work
- ...facility on-site and/or telephonic concurrent reviews and discharge planning and coordination... ...to medical and behavioral complex case managers . Coordinates and supports all discharge... ...applications. Current and unrestricted Florida RN license. Case management and health...Private practiceWork at office
- ...seeking a qualified individual to support facility reviews and discharge planning in Miami, Florida. Responsibilities... .... The ideal candidate will have a current Florida RN license and 3 years of experience in case management or prior authorization. Familiarity with Interqual...
- ...Associate Nurse Manager Jackson Memorial Hospital... ...Organizational Impact: Collaborates with... ...by partnering with case management and... ...nursing unit, and utilizing the iRounding patient... ...workforce targets. Reviews, and approves time... ...At least 3 years of RN experience within Critical...Full timeTemporary workImmediate startShift workNight shift
- ChenMed is seeking a Physician Reviewer to lead Utilization Management cases across multiple markets. The role covers delegated UM duties, coordination with health plans, and collaboration with local teams to ensure optimal patient care. A medical degree, active unrestricted...Local area
- ChenMed is seeking a Physician Reviewer to lead Utilization Management reviews for seniors in a rapidly expanding, physician-led organization. Based in Florida, you will support delegated UM cases, participate in health-plan and local calls, and contribute to process and...Local area
- ChenMed is hiring a Physician Reviewer for Utilization Management to oversee delegated UM cases across multiple markets, supporting health plan calls and local teams. You will participate in care coordination and contribute to ongoing quality initiatives within our expanding...Local area
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