Top 54 Utilization review nurse Jobs in Miramar, Fl

Utilization Review Nurse
Oscar Health —Miami, FL
- $35.00 - $45.94 an hour
- Weekends as needed
- Remote
- Nursing
- RN License
- Mid-level
- Paid parental leave
- Paid holidays
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Registered Nurse Utilization Review, Case Management
West Kendall Baptist Hospital —Miami, FL
- $47 an hour
- Weekends as needed
- Nursing
- RN License
- Mid-level
- Wellness program
- Health insurance
5d
Care Review Clinician (RN) - Remote in FL
Molina Healthcare —Miami, FL
- $26.41 - $51.49 an hour
- Full-time
- Remote
- RN License
- Mid-level
- Critical & Intensive Care
- Health insurance
Care Review Clinician, Specialty Therapist (Occupational / Physical / Speech) - REMOTE from Florida
Molina Healthcare —Miami, FL
- $26.41 - $51.49 an hour
- Full-time
- Remote
- Physical & Rehabilitation Medicine
- Mid-level
- Physical Therapy License
- Health insurance
Clinical Documentation Integrity - Second Level Reviewer
University of Miami —Hialeah, FL
- Full-time
- Remote
- Nursing
- Medicine
- Microsoft Excel
- Health insurance
- Dental insurance
Utilization Review Specialist
We Level Up —Pompano Beach, FL
- $50,000 - $90,000 a year
- Full-time
- Remote
- 18 years or older
- CPR Certification
- HIPAA
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Utilization Review
Westchester General Hospital —Miami, FL
- Overtime
- Nursing
- RN License
- Hospital
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Concurrent Review Nurse
Leon Health —Miami, FL
- Spanish
- Nursing
- English
6d
UTILIZATION REVIEWER
Larkin Community Hospital —South Miami, FL
- Full-time
- Spanish
- RN License
- English
10d
Utilization Management Nurse
Solis Health Plans —Doral, FL
- $60,000 - $70,000 a year
- Full-time
- Spanish
- Nursing
- RN License
- Health insurance
- Dental insurance
Quick Apply
12d
Care Review Clinician (BH Licensed) - Remote in FL
Molina Healthcare —Miami, FL
- $26.41 - $51.49 an hour
- Full-time
- Remote
- LMFT
- Licensed Clinical Social Worker
- Mid-level
- Health insurance
UM Clinical Reviewer
Centers Plan for Healthy Living —Margate, FL
- Full-time
- RN License
- Communication skills
- Entry level
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Case Manager
West Gables Rehabilitation Hospital —Miami, FL
- $75,000 - $112,000 a year
- Full-time
- Hospital
- Inpatient
- Mid-level
- Dental insurance
- Paid time off
Quick Apply
RN Case Manager
Cleveland Clinic —Weston, FL
- Full-time
- Acute care
- Nursing
- RN License
4d
Home Health Wound Care RN
OneHome —Miramar, FL
- $77,200 - $106,200 a year
- Full-time
- RN License
- Home Health
- Senior level
- Paid parental leave
- Paid holidays
Team Manager Home Care
VITAS Healthcare —Miramar, FL
- Full-time
- RN License
- Mid-level
- Bachelor's degree
- Disability insurance
- Health insurance
Quick Apply
12d
Manager, Case Management
University of Miami —Miami, FL
- Full-time
- RN License
- Hospital
- Word processing
- Health insurance
- Dental insurance
RN Community Case Manager
Chen Medical Associates —North Miami Beach, FL
- $36.90 - $52.70 an hour
- Full-time
- Acute care
- Nursing
- Microsoft Outlook
- Opportunities for advancement
5d
Case Management RN
Sanitas Medical Center —Doral, FL
- Full-time
- Spanish
- Master of Social Work
- Nursing
Quick Apply
Case Manager, Acute Care - Case Mgmt - Pool Days - BHMC
Broward Health —Fort Lauderdale, FL
- Day shift
- Acute care
- Nursing
- RN License

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utilization review nurse jobs near miramar, fl

Utilization Review Nurse

Oscar Health -
Miami, FL

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Job Details

$35.00 - $45.94 an hour

Benefits

Paid parental leave
Paid holidays
Disability insurance
Health insurance
Dental insurance
Parental leave
Vision insurance
Paid sick time

Qualifications

Nursing
Utilization review
Managed care organization experience
Acute care facility experience
Utilization management
Decision making
Resource utilization in healthcare
Milliman Care Guidelines (MCG Health)
Nursing

Full Job Description

Hi, we're Oscar. We're hiring a Utilization Review Nurse to join our Utilization Review team.

About the role:

You will perform frequent case reviews, check medical records and speak with care providers regarding treatment as needed. You will make recommendations regarding the appropriateness of care for identified diagnoses based on the research results for those conditions.

You will report into the Supervisor, Utilization Review.

Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois; Iowa; Kansas; Michigan; Missouri; Nebraska; New Jersey; North Carolina; Ohio; Oklahoma; Pennsylvania; South Carolina; Tennessee; Texas; or Virginia. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events.

Pay Transparency: The base pay for this role is: $35.00 - $45.94 per hour. You are also eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year.

Responsibilities:

Complete medical necessity reviews and level of care reviews for requested services using clinical judgment and Oscar Clinical Guidelines, Milliman Care Guidelines
Obtain the information necessary (via telephone and fax) to assess a member's clinical condition, and apply the appropriate evidence-based guidelines
Meet required decision-making SLAs
Refer members for further care engagement when needed
Compliance with all applicable laws and regulations
Other duties as assigned

Requirements:

Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC)
Associate Degree - Nursing or Graduate of Accredited School of Nursing Or Successful completion of Nursing Diploma Program in Accredited School of Nursing
Ability to obtain additional state licenses to meet business needs
1+ year of utilization review experience in a managed care setting
Strong experience utilizating MCG (Milliman Care Gudielines)
1+ years of clinical experience (including at least 1+ year clinical practice in an acute care setting, i.e., ER or hospital)
Weekend availability is required; all applicants must be able to work at least one weekend day (Saturday or Sunday) each week.

Bonus points:

BSN
Previous experience conducting concurrent or inpatient reviews for a managed care plan

This is an authentic Oscar Health job opportunity. Learn more about how you can safeguard yourself from recruitment fraud here.

At Oscar, being an Equal Opportunity Employer means more than upholding discrimination-free hiring practices. It means that we cultivate an environment where people can be their most authentic selves and find both belonging and support. We're on a mission to change health care - an experience made whole by our unique backgrounds and perspectives.

Pay Transparency: Final offer amounts, within the base pay set forth above, are determined by factors including your relevant skills, education, and experience. Full-time employees are eligible for benefits including: medical, dental, and vision benefits, 11 paid holidays, paid sick time, paid parental leave, 401(k) plan participation, life and disability insurance, and paid wellness time and reimbursements.

Artificial Intelligence (AI): Our AI Guidelines outline the acceptable use of artificial intelligence for candidates and detail how we use AI to support our recruiting efforts.

Reasonable Accommodation: Oscar applicants are considered solely based on their qualifications, without regard to applicant's disability or need for accommodation. Any Oscar applicant who requires reasonable accommodations during the application process should contact the Oscar Benefits Team ([email protected]) to make the need for an accommodation known.

California Residents: For information about our collection, use, and disclosure of applicants' personal information as well as applicants' rights over their personal information, please see our Privacy Policy.

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Refine Your Search

utilization review nurse jobs in miramar, fl

Utilization Review Nurse

Registered Nurse Utilization Review, Case Management

Care Review Clinician (RN) - Remote in FL

Care Review Clinician, Specialty Therapist (Occupational / Physical / Speech) - REMOTE from Florida

Clinical Documentation Integrity - Second Level Reviewer

Utilization Review Specialist

Utilization Review

Concurrent Review Nurse

UTILIZATION REVIEWER

Utilization Management Nurse

Care Review Clinician (BH Licensed) - Remote in FL

UM Clinical Reviewer

Case Manager

RN Case Manager

Home Health Wound Care RN

Team Manager Home Care

Manager, Case Management

RN Community Case Manager

Case Management RN

Case Manager, Acute Care - Case Mgmt - Pool Days - BHMC

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