RN Utilization Review & Appeals Specialist (Day Shift)
Molina Healthcare
Molina Healthcare is seeking a Registered Nurse with utilization management and appeals review experience to assess medical necessity and appropriate care levels in a managed care setting. You will validate records, support appeals, and ensure accurate coding for reimbursement. Responsibilities include handling prospective, retrospective, and concurrent reviews, collaborating with medical directors, and assisting with complex claims and denial decisions while maintaining compliance with state #J-18808-Ljbffr Molina Healthcare
Vacancy posted 4 days ago
Similar jobs that could be interesting for youBased on the RN Utilization Review & Appeals Specialist (Day Shift) in Miami Beach, FL vacancy
$47 per hour
...Registered Nurse Utilization Review, Case Management The purpose... ...delays and denied days. They are accountable... ...opportunities for expedited appeals and collaborates... ...0 / hour depending on shift as applicable. Shift Note... ...leadership role as an RN; however, required to...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 criteria and regulations. The role involves documenting in the UM system, coordinating with pre-authorization teams,...Suggested
$20.51 - $27.21 per hour
...Reimbursement Specialist Adventist HealthCare seeks to hire an experienced... ...on billed, resubmitted, appealed and reconsideration claims. Files appeal after review of a denial indicates an... ...pm Monday through Friday Shift Type: Day Shift-Hybrid Schedule Holiday...Day shiftDaily paidFull timeTemporary workWork at officeMonday to FridayFlexible hoursShift work- ...Utilization Management Specialist Under general supervision by management, and in collaboration... ...to authorize services. Reviews health care services to... ...a Doctor for 15 mins every day. Travel maybe required to a... ...LCMFC, LMHC, LMFT, LCPC or RN. OR RN, then a Bachelor...SuggestedContract workLocal area
- AppleOne Employment Services seeks an experienced RN Case Management professional for a direct hire opportunity in Miami, FL... ...for a Florida-licensed Registered Nurse who enjoys clinical review, utilization management, patient and provider communication, and careful interpretation...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...Hourly pay- Uloop Inc. is looking for a Utilization Management Coordinator to join our team. This role is crucial for ensuring efficient delivery of... ...qualifications include an Associate degree in Health Administration and certifications in Utilization Review. #J-18808-Ljbffr Uloop Inc.
- ...Health Wellpoint Federal in the United States is seeking a Clinical Review Nurse Senior to coordinate and oversee the work of clinical... ...and the non-clinical support team. The role offers 8-hour day shifts, with virtual full-time work and in-person training as required...Day shiftRemote jobFull time
$2,572 per week
...Registered Nurse (RN) | Cardiac Catheterization Lab Location: Miami, FL... ...Staffing Pay: $2,572 per week Shift Information: Days - 5 days x 8 hours Contract Duration... ...clients and candidates. Prime Staffing utilizes a unique matchmaking approach, providing...Day shiftPermanent employmentFull timeContract workTemporary workFlexible hoursShift workNight shiftWeekend workTravelNurseSource
Miami, FL1 day ago- ...improved cardiac imaging care processes. The position is mainly a day shift, on occasion overtime may be needed. Required Qualifications... .... Knowledge, Skills and Attitudes: Ability to review goals, and objectives that support the strategic plan. Ability...Day shiftFull timeWork at officeWorldwide
$20.98 - $30.12 per hour
...up with insurers to recover inaccurate payments. Reviews accounts to ensure accuracy of billing/charging utilizing knowledge of pre-certification /prior authorization... ...information and professionalism. Performs appeals process when appropriate. Promotes accuracy among...Immediate startRemote workGrabJobs
Hialeah, FL19 hours ago- Position Overview Shift : Full‑Time - (40 hrs. M‑F) Days (depending on availability). Occasional on‑call and rotating weekends may be required. Work Location... ...MRI environments. Knowledge, Skills and Attitudes : Review goals and objectives that support the strategic plan....Day shiftFull timeWork at officeShift work
- ...Revenue Cycle Specialist The Revenue Cycle Specialist role is to... ...impacting revenue for timely review and claims submission (Front/... ...Follow up on unpaid claims, appeals of denied claims and post payments... ...to charge capture. Utilize the coding resources to understand...Work experience placementWork at office
Community Health of South Florida
Miami, FL4 days ago - ...Adult Psych The Mental Health Specialist (MHS) is a member of the care... ...and duties as directed by the RN and outlined in the hospital's... .../intervene per protocol. Utilize verbal de-escalation techniques... ...assignments left from previous shifts and reports any incomplete assignments...Day shiftFull timeWork at officeShift work
- ...Banking Specialist IVAs a Banking Specialist IV, you help create the energy... ...the right products. Every day is an opportunity for you to turn... ...all products and services.Review customers account activity to... ...Centers: Responsible and able to utilize all elements within a...Work experience placementWork at officeNight shift
Amerant Bank
Miami Beach, FL4 days ago - Hospice Clinical Team Manager (RN Required) North Miami Beach,... ...Job Schedule Full time Job Shift Day Job Description The Team Manager... ...plan of care. Reviews information on all pending patient... ...annual program review. Performs utilization review of continuous care and...Day shiftFull timeContract workLocal areaFlexible hoursShift workNight shiftWeekend workWeekday work
- ...Clinical Documentation Specialist CDI Florida residency required... ...and determine priorities Reviews all patient records in his/her... ...and subsequently beween 2-3 days until discharge, as needed. Manages... ...documentation improvement by utilizing sound clinical reasoning and...Relocation
Mount Sinai Hospital
Miami Beach, FL4 days ago - ..., FL, seeks an experienced Registered Nurse for full-time days with a 3-day, 12-hour shift pattern and rotating weekends. The role involves comprehensive... ...teams to ensure quality outcomes. Licensed as a Florida RN with BLS and ACLS, you will provide high-quality bedside...Day shiftFull timeInternshipRotating shift
- ...something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We... ...Best Workplaces in Financial Services & Insurance Estimate Review Specialist Sr. PRIMARY PURPOSE : To review all estimates and supporting...Temporary workFor contractorsWork at officeLocal area
$39.34 - $56.2 per hour
...Wound Care Utilization Management RN Wound Care Utilization Management RN Virtual: This role enables... ...impact on whole health. Work Shift Hours: Monday through Friday, 8:00AM to... ...collaborative care plans with providers. Reviews Home based services for clinical...Full timeWork at officeRemote workMonday to FridayShift work- ...Clinical Member Services Reviewer Provides support for clinical member services review... ...promote the Molina care model. Adheres to utilization management (UM) policies and procedures.... ...and experience. Registered Nurse (RN). License must be active and unrestricted...Work at office
- Camillus House is seeking a dependable Kitchen Utility Technician / Dishwasher in South Florida to maintain a clean, safe dining environment for clients, staff, volunteers, and visitors. You will operate dishwashing equipment, support daily food service operations, and...
$18 - $24 per hour
...Revenue Cycle Specialist III The Revenue Cycle Specialist III is... ...ensure timely claim submission Review, research, and correct claims... ...in preparing and submitting appeals and reconsiderations to... ...to communicate directives Utilizes proper body mechanics in multiple...- ...needs. We have four adult day health centers that... ...Job Title Eligibility Specialist PACE Job Summary Screens... ...certifications, and files appeals for denials with... ...Children and Families Reviews eligibility workflow and... ...information Identifies and utilizes appropriate channels of...Full timePart timeLocal areaRelocation
$26.41 - $61.79 per hour
...Provides support for clinical member services review assessment processes. Responsible for... ...the Molina care model. Adheres to utilization management (UM) policies and procedures.... ...education and experience. Registered Nurse (RN) with an active and unrestricted license...Hourly payWork experience placementWork at office- Jobtailor in Miami is seeking a Provider Enrollment Specialist to plan and conduct in-house and on-site reviews for Medicaid providers, verify licenses, tax receipts, and lease information, and submit findings for action. You will research business status online and coordinate...
- ...faculty or staff position, please review this tip sheet ( . CORE JOB... ...a culturally competent manner utilizing evidence-based standards of... ...:Valid State of Florida RN license requiredRefer to department... ...appointments are confirmed either the day before scheduled appointment...Day shiftFull timeTemporary workCasual workWork at officeWorldwideMonday to Friday
University of Miami
Miami, FL1 day ago $2,565 per week
...Registered Nurse (RN) | Cardiac Catheterization Lab Location: Miami, FL Agency: Advantis Medical Staffing Pay: $2,565 per week Shift Information: Days - 4 days x 10 hours Contract Duration: 13 Weeks Start Date: 8/17/2026 About the Position...Day shiftFull timeContract workImmediate startShift workTravelNurseSource
Miami, FL1 day ago$2,565 per week
...Registered Nurse (RN) | Cardiac Catheterization Lab Location: Miami, FL Agency: Advantis Medical Staffing Pay: $2,565 per week Shift Information: Days - 4 days x 10 hours Contract Duration: 13 Weeks Start Date: 8/17/2026 About the Position...Day shiftFull timeContract workImmediate startShift workAdvantis Medical Staffing
Miami, FL1 day ago$2,499 per week
...Registered Nurse (RN) | Cardiac Catheterization Lab Location: Miami, FL Agency: Cynet Health Pay: $2,499 per week Shift Information: Days - 4 days x 10 hours Contract Duration: 13 Weeks Start Date: 8/17/2026 About the Position Job Title...Day shiftFull timeContract workFlexible hoursShift workNight shiftWeekend workCynet Health
Miami, FL1 day ago
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to RN Utilization Review & Appeals Specialist (Day Shift). Be the first to apply!
Related searches
- fema rn Miami Beach, FL
- icu rn Miami Beach, FL
- school rn Miami Beach, FL
- labor and delivery registered nurse rn Miami Beach, FL
- rn Miami Beach, FL
- rn iv therapy Miami Beach, FL
- rn quality Miami Beach, FL
- outpatient registered nurse Miami Beach, FL
- radiology - rn Miami Beach, FL
- full-time registered nurse rn Miami Beach, FL