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$29.05 - $67.97 per hour
...organization in Jacksonville, Florida seeks a qualified RN to support medical claims and internal appeals review activities. Responsibilities include clinical... ...of two years of nursing experience, including utilization review. The position offers a competitive hourly pay...SuggestedHourly pay- A healthcare management organization is seeking a Clinical Care Reviewer II in Jacksonville, FL. This role is responsible for processing... ...members. Candidates must have an Associates in Nursing and a current RN license, with three years of clinical experience preferred....SuggestedHourly pay
- A large healthcare provider in Tampa is seeking a Utilization Review Specialist Senior. This hybrid position involves acting as a liaison for funding agents and ensuring appropriate levels of care through comprehensive reviews. Candidates must have a Registered Nurse license...SuggestedWeekend work
- ...the internal application process. To learn how to apply for a faculty or staff position, please review this tip sheet ( . The purpose of the Utilization Case Manager RN is to conduct initial chart reviews for medical necessity and identify the need for authorization...SuggestedFull timeTemporary workWork at officeWorldwide
University of Miami
Miami, FL3 days ago $47 per hour
A prominent healthcare provider in Miami is seeking a Registered Nurse for a critical role in conducting chart reviews and coordinating patient care. This position requires an Associate's Degree in Nursing and 3 years of clinical experience. The ideal candidate will possess...SuggestedHourly payShift work- ...Utilization Case Manager RN The purpose of the Utilization Case Manager RN is to conduct initial chart reviews for medical necessity and identify the need for authorization. The Utilization Case Manager RN coordinates with the healthcare team for optimal and efficient...SuggestedWork at office
$29.05 - $67.97 per hour
A healthcare provider in Tampa seeks an experienced Registered Nurse (RN) for clinical support in medical claim and appeal reviews. You will utilize your clinical expertise to validate claims and ensure adherence to healthcare guidelines, serving as a key resource for...SuggestedHourly pay- A leading behavioral health organization in Leesburg, FL, seeks a Utilization Review Manager - RN to oversee the utilization review process, ensuring patient care services are optimized and compliant with standards. The ideal candidate possesses a current RN license in...SuggestedFlexible hours
- A leading university in healthcare is seeking a Utilization Case Manager RN in Miami, FL. This role involves conducting chart reviews for medical authorization and coordinating with healthcare teams for effective patient care. Candidates must have a Bachelor's degree in...SuggestedFull time
$47 per hour
...to conduct initial, concurrent, retrospective chart review for clinical, financial and resource utilization. Coordinates with healthcare team for optimal efficient... ...a BSN to continue their non‑leadership role as an RN; however, required to complete the BSN within 3...SuggestedDaily paidLocal areaShift work$62.7k - $100.4k
Job Summary Clinical Care Reviewer II is responsible for processing medical necessity reviews... ...of an accredited registered nursing (RN) degree program required Three (3) years... ...care or home health experience preferred Utilization Management/Utilization Review experience...SuggestedHourly payWork at office- ...dignity, respect, responsibility and clinical excellence. The Utilization Review Specialist Senior responsibilities include: Functions as the... ...Preferred experience includes Critical Care or Emergency Nursing RN. Position details: Location: Hybrid - St Josephs Hospital/...SuggestedReliefWeekend work
- A treatment center in Florida is seeking a Utilization Review Specialist responsible for managing insurance authorizations and ensuring compliance with payer requirements. The ideal candidate has over 3 years of experience in behavioral health, excellent communication...Suggested
- A leading healthcare provider in Jacksonville is seeking a TEMP FT Utilization Review Coordinator to monitor treatment activities and ensure quality patient care. The ideal candidate will have a nursing or social work background with experience in Utilization Management...SuggestedTemporary workWeekend work
$80k - $85k
Utilization Review Nurse | Corporate Utilization Management | PRN | Variable - UF Health Overview FTE‑.10 PRN Variable shift The Utilization Review Nurse is responsible for evaluating the appropriateness of hospital admissions, resource utilization, and medical necessity...SuggestedFull timeReliefShift work$71.2k - $127.2k
A healthcare institution in Leesburg, Florida is seeking a Utilization Review Nurse to assess hospital admissions and resource utilization. The role involves ensuring timely patient discharges and upholding accurate medical documentation. The ideal candidate will possess...ReliefShift work- Utilization Review Specialist Palm Springs, Florida, United States Yoso Recruiting
- ...services firm based in the US is seeking a remote Medical Claim Review Nurse. In this role, you will conduct clinical reviews of medical... ...of 3 years of experience in clinical appeals review and an active RN license. This full-time position offers a structured schedule and...Full timeRemote work
Integrated Resources
Orlando, FL2 days ago $40 per hour
...A healthcare quality organization is seeking a Nurse Reviewer to support Medical Review Services. The role involves conducting detailed... ...a remote work setting. Candidates should have a BSN with active RN licensure and at least three to five years' experience in medical...Hourly payPart timeRemote workHQSI
Tampa, FL4 days ago- ...leading pharmacy benefits manager is seeking a Physician Clinical Reviewer specialized in Dermatology for a remote role. This position... ...experience. This is an opportunity to contribute to effective utilization management processes while working within a supportive team...Remote work
Prime Therapeutics
Tallahassee, FL4 days ago $29.05 - $67.97 per hour
...support for medical claim and internal appeals review activities - ensuring alignment with... ...Resolves escalated complaints regarding utilization management and long-term services and supports... ...and experience. Registered Nurse (RN). License must be active and unrestricted...Hourly payWork experience placementWork at office$26.5 - $47.59 per hour
...Clinical Review Nurse - Concurrent Review Be among the first 25 applicants and get AI-powered advice on this job and more exclusive... ...work Eastern or Central Standard Time. Registered Nurse (RN) with utilization management, concurrent review, and acute care experience...Hourly payWork at officeRemote workFlexible hoursCentene Corporation
Orlando, FL4 days ago- ...Job Description Job Description TITLE: Utilization Management Physician (UMP) Location: Remote Employment Type: Full-Time Position... ...communication skills. The physician will be responsible for reviewing cases, determining medical necessity, and supporting evidence-...Remote jobFull timeRelocation package
The Provider Finder
Daytona Beach, FL6 days ago - ...RN Utilization Management Nurse – Frontline Opportunity Greater Orlando, Florida The RN Utilization Management Nurse uses clinical expertise... ...to the Physician Advisor or designated leader for additional review as determined by department standards. Additionally, the RN...Work at office
healthcarerecruitmentpartners.com
Orlando, FL4 days ago - ...who want to be part of our mission and join our team! As a Utilization Review Nurse, you will utilize your critical thinking skills, clinical... ...~ Licensed Nurse Practitioner (LPN) or Registered Nurse (RN) required ~ Comprehensive knowledge of general nursing...Local area
Turning Point Plans
Lake Mary, FL1 day ago $75k - $100k
Our Utilization Management RN (Registered Nurse) evaluates efficiency, appropriateness, and medical necessity for medical services, and procedures... .... This role uses clinical knowledge to provide judgment to review medical services with evidence‑based criteria, authorize...For contractorsWork at officeImmediate startRemote work- ...is actively seeking a dedicated and experienced Medical Case Reviewer/Analyst to join their client's team. This position is 100% onsite... ..., Neurology, or surgery is a plus. Prior experience with utilization review, developing medical chronologies, or legal experience is...Temporary workLocal areaMonday to FridayDay shift
Ultimate LLC
Oldsmar, FL1 day ago - ...Clinical Reviewer The Clinical Reviewer serves as a subject matter expert in the clinical... ...issues derived from developed claims Utilize internal system, external platforms and appropriate... ...or equivalent Active and unrestricted RN or LPN license or equivalent Coding...Contract workFor contractors
DOCTORS HEALTHCARE PLANS, INC.
Miami, FL1 day ago - ...for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works within a multidisciplinary team to help identify... ...interventions are maintained. Qualifications: Active RN license, entry level RN welcome Excellent written and...Full timeWork at office
Centers Plan for Healthy Living
Coconut Creek, FL3 days ago - ...Job Description Job Description Care Review Specialist – Exact Billing Solutions (EBS) Lauderdale Lakes, FL - On-site... ...will play a pivotal role in ensuring the efficient and effective utilization of healthcare resources. The Care Review Specialist will assist...Work at officeFlexible hours
ICBD
Fort Lauderdale, FL25 days ago
