Utilization review jobs in Florida

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RN-Utilization Review - PT Weekends

 ...Job Description We Are Hiring: Ascension Sacred Heart is looking for an RN- Utilization review to join our team. In this role you will need to live in the Pensacola area but will primarily be working remotely.    Work Schedule: Weekends - Saturday and Sunday... 

Ascension

Pensacola, FL
15 days ago

Utilization Review Specialist

 ...parkroyalhospital.com! PURPOSE STATEMENT: Proactively monitor utilization of services for patients to optimize reimbursement for the...  ...and the facility professional clinical staff. Conduct reviews, in accordance with certification requirements, of insurance plans... 

Park Royal Hospital

Fort Myers, FL
12 days ago

Manager Utilization Management Review

 ...the clinical coordination components of the Behavioral Health Utilization Management Program. Works in close collaboration with all departments...  ...authorization, medical necessity determinations, concurrent review, retrospective review, continuity of care, care coordination,... 

Amerihealth

Palm Beach Gardens, FL
28 days ago

Utilization Review Specialist

 ...Job Description The Utilization Review Specialist is responsible for establishing and maintaining contracts with managed care companies. Job Responsibilities: # Establishes and maintains contracts with managed care companies and requests rate increases when deemed... 

Serenity Oak Wellness

Fort Lauderdale, FL
5 days ago

Denials Specialist - Utilization Review

 ...The Denials Specialist - Utilization Review is responsible for timely review of all payor, inpatient and outpatient claims, which have been denied, or may not meet medical necessity. Working closely with the Physician Advisors, Registration, Central Business Office... 

Baycare Health System, Inc

Saint Petersburg, FL
17 days ago

Regional Utilization Review & Intake Specialist Full-Time

The Utilization Review and Intake Specialist assists patients and families access treatment by providing information, conducting pre-admission screenings/assessments, and coordinating admissions to the clinic. They obtain insurance information on behalf of prospective... 

Rogers Behavioral Health

Miami, FL
7 days ago

Mgr Utilization Review, Case Management, Full time, 8A-4:30P

 ...admission to discharge. Serves as a resource to the hospital for utilization management, regulatory, and denial issues. Interfaces with...  ...Coordinators to address opportunities identified in clinical reviews.Minimum required experience 5 years. Bachelor's Degree required... 

Baptist Health South Florida

Miami, FL
4 days ago

Utilization Review Nurse

 ...downtown Tampa.Job SummaryUnder general supervision of the Utilization Management Manager, the Utilization Management Nurse will...  ...with the attending physician; Utilize clinical skills, chart review, physician communication and Interqual Level of Care and utilize... 

The Tampa General Hospital Foundation Inc

Tampa, FL
12 days ago

Travel Nurse RN - Utilization Review - $2,370 per week

 ...KPG Healthcare is seeking a travel nurse RN Utilization Review for a travel nursing job in Tampa, Florida. Job Description & Requirements ~ Specialty: Utilization Review ~ Discipline: RN ~ Start Date: 07/12/2021 ~ Duration: 13 weeks ~40 hours per week... 

Vivian Health

Tampa, FL
5 days ago

Manager, Utilization Review

 ...Description: The Manager Utilization Review plans, organizes and supervises the activities of the Utilization Team, prepares department for internal and external audits, conducts utilization management delegation audits and develops policies and procedures for adherence... 

BayCare

Safety Harbor, FL
18 days ago

Clinical Denial/Utilization Review Nurse-RN/BSN

Clinical Denials-Utilization Review NurseOverview of PositionThe Clinical Denial Utilization Review Nurse is responsible for conducting clinical reviews to justify and dispute payer denials. The role will develop case studies, coordinate with hospital operations and payers... 

Change Healthcare Solutions, LLC

Miami, FL
14 days ago

Utilization Review Specialist Senior

The Senior Utilization Review Specialist functions as the primary liaison between the funding agents and all other related parties to ensure appropriate level of care through comprehensive concurrent review for medical necessity of outpatient observation and inpatient... 

Baycare Homecare

Tampa, FL
6 hours ago

Utilization Review Nurse

 ...Job Description Hi, we're Oscar. We're hiring a Utilization/Clinical Review Nurse to join our Clinical team.  Oscar is a technology-driven, consumer-focused health insurance startup founded in 2012 and headquartered in New York City. Our goal is to make health... 

Oscar Health

Miami, FL
13 days ago

Registered Nurse - RN (Utilization Review - UR)

 ...Job Description Chesapeake Medical Staffing RN Util Review Chesapeake Medical Staffing (CMS) is currently seeking a RN - Util Review for agency contract positions in Winter Haven, FL Details: RN-Util Review Location: Winter Haven, FL Shift Time:... 

Chesapeake Medical Staffing

Winter Haven, FL
19 days ago

Manager Utilization Management Review

 ...sensitive information. Special Instructions to Applicants: Application Deadline: Applications are accepted electronically ONLY at Review of applications will begin immediately and will continue until the position is filled.Application Materials Required: Cover Letter,... 

AmeriHealth Caritas Health Plan

Palm Beach Gardens, FL
2 days ago

Utilization Management Nurse Reviewer - Wound Care

 ...rankings and lower healthcare costs. We are looking for several experienced and motivated Wound Care Nurses to join our team of Utilization Review professionals. The WOC Nurse will monitor and authorize home care services for complex wound case. As part of our team, you... 

Max Populi, LLC

Hollywood, FL
15 days ago

Utilization Review Specialist Senior

Utilization Review Specialist Senior( Job Number: 215940) Description The Senior Utilization Review Specialist functions as the primary liaison between the funding agents and all other related parties to ensure appropriate level of care through comprehensive concurrent... 

BayCare Health System

Riverview, FL
10 hours ago

Utilization Review (UR) Clinical Specialist - FT

 ...May also work as needed at Bayfront Health Punta Gorda campus*Utilization management is the analysis of the necessity, appropriateness,...  ...services and procedures in the hospital setting. Utilization review is the assessment for medical necessity, both for admission to... 

Bayfront Health - Port Charlotte

Port Charlotte, FL
9 hours ago