Top 17 Utilization review Jobs in Ocala Fl

Care Review Clinician (BH Licensed) - Remote in FL
Molina Healthcare, Inc. —Florida
- $26.41 - $51.49 an hour
- Full-time
- Remote
- LMFT
- Licensed Clinical Social Worker
- Mid-level
- Health insurance
Outpatient Manager
The Vines Hospital —Ocala, FL
- Full-time
- Background check
- Addiction Medicine
- Licensed Clinical Social Worker
- Health savings account
- Health insurance
Quick Apply
2d
Care Management Social Worker
AdventHealth Ocala —Ocala, FL
- $23.71 - $44.09 an hour
- Full-time
- Background check
- Microsoft Outlook
- Customer service
- Paid parental leave
- Disability insurance
Utilization Specialist
The Refuge, A Healing Place —Ocklawaha, FL
- $20 - $24 an hour
- Full-time
- CPR Certification
- Nursing
- BLS Certification
7d
Administrator
ADDICTION AND MENTAL HEALTH SERVICES, LLC —Ocala, FL
- Full-time
- Clean driving record
- Addiction Medicine
- Customer service
- Loan repayment program
- Health insurance
Hospital Case Manager
Premier Medical Assoicates —Ocala, FL
- $23.10 - $27.81 an hour
- Full-time
- Acute care
- Master of Social Work
- Nursing
- Health insurance
- Dental insurance
Quick Apply
1d
Outpatient Clinical Program Manager
The Vines Behavioral Health Hospital —Ocala, FL
- Full-time
- Addiction Medicine
- Licensed Clinical Social Worker
- Adults
- Health insurance
- Dental insurance
10d
MDS Resource
Everglades Healthcare —Ocala, FL
- $86,000 - $91,000 a year
- Weekends as needed
- Nursing
- Skilled nursing facility
- RN License
- Health insurance
- Dental insurance
Quick Apply
5h
Home Health Clinical Manager
Centerwell —The Villages, FL
- $77,200 - $106,200 a year
- Full-time
- CPR Certification
- Nursing
- RN License
- Paid parental leave
- Paid holidays
Case Manager / PRN ( RN / RT / SW / LPN )
Select Specialty Hospital - The Villages —Oxford, FL
- Part-time
- Master of Social Work
- RN License
- Inpatient
- Employee assistance program
- Opportunities for advancement
Quick Apply
Hospice Clinical Team Manager (RN Required)
VITAS Healthcare —Ocala, FL
- Full-time
- Nursing
- RN License
- Mid-level
- Disability insurance
- Health insurance
Quick Apply
Associate Medical Director
CenterWell Senior Primary Care —The Villages, FL
- Online Application
- Background check
- Medicine
- BC/BE
- Paid jury duty
- Health savings account
Hospital - Clinical Pharmacist Specialist (Bone Marrow Transplant)
UT Health Science Center at San Antonio —United States
- Hospital
- Outpatient experience
- 3 years
Quick Apply

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Outpatient Manager
The Vines Hospital —Ocala, FL
The Outpatient Clinical Program Manager is responsible for program development, business strategy and development, marketing, personnel management activities,…
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2d
Administrator
ADDICTION AND MENTAL HEALTH SERVICES, LLC —Ocala, FL
Valid driver's license with a safe driving record required. Manage day-to-day business office operations, including billing, collections, admissions processing,…

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Care Review Clinician (BH Licensed) - Remote in FL

Molina Healthcare, Inc. -
Florida

Apply Now

Job Details

Full-time
$26.41 - $51.49 an hour

Benefits

Health insurance

Qualifications

Productivity software

Full Job Description

JOB DESCRIPTION Job Summary

Provides support for member clinical service review processes specific to behavioral health. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations, and ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care.

Essential Job Duties

Assesses services for members - ensuring optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines.
Analyzes clinical service requests from members or providers against evidence based clinical guidelines.
Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures.
Conducts reviews to determine prior authorization / financial responsibility for Molina and its members.
Processes requests within required timelines.
Refers appropriate cases to medical directors and presents cases in a consistent and efficient manner.
Requests additional information from members or providers as needed.
Makes appropriate referrals to other clinical programs.
Collaborates with multidisciplinary teams to promote Molina care model.
Adheres to utilization management (UM) policies and procedures.
May work collaboratively with appropriate departments to provide applied behavior analysis (ABA)/behavioral health therapy (BHT) services to Molina members with autism spectrum disorder (ASD) and other related disorders.
May approve requests for BHT by reviewing behavioral assessments and treatment plans for medical necessity and BHT best practice guidelines. This includes but is not limited to: psychological evaluation requests, comprehensive diagnostic evaluations, functional behavioral assessments, and progress reports.
May perform ongoing monitoring of BHT treatment plans to evaluate effectiveness and treatment efficacy.
May provide peer to peer consultation BHT in-network providers to support treatment planning and maximize member progress.
May work collaboratively with ABA providers to ensure best service practices for members.
May create and develops forms, recommendations and guidelines and training for BHT service delivery.
May collaborate and coordinate with behavioral health medical directors, and senior medical directors to ensure proper management of the BHT benefit.

Required Qualifications

At least 2 years health care experience, including experience in behavioral health and/or hospital acute care, or equivalent combination of relevant education and experience.
Licensed Clinical Social Worker (LCSW), Licensed Master Social Worker (LMSW), Licensed Professional Counselor (LPC), Licensed Professional Clinical Counselor (LPCC), Licensed Marriage and Family Therapist (LMFT) or equivalent behavioral health licensure. License must be active and unrestricted in state of practice.
May require behavioral analyst experience, and/or board certification/licensure as a behavioral analyst (BCBA and/or LBA).
Demonstrated knowledge of community resources.
Ability to operate proactively and demonstrate detail-oriented work.
Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations.
Ability to work independently, with minimal supervision and demonstrate self-motivation.
Responsive in all forms of communication, and ability to remain calm in high-pressure situations.
Ability to develop and maintain professional relationships.
Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change.
Excellent problem-solving, and critical-thinking skills.
Strong verbal and written communication skills.
Microsoft Office suite/applicable software program(s) proficiency.

Preferred Qualifications

Recent hospital behavioral health experience in an intensive care unit (ICU) or emergency room.

#PJHS3

#LI-AC1

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Apply Now

Refine Your Search

utilization review jobs in ocala fl

Care Review Clinician (BH Licensed) - Remote in FL

Outpatient Manager

Care Management Social Worker

Utilization Specialist

Administrator

Hospital Case Manager

Outpatient Clinical Program Manager

MDS Resource

Home Health Clinical Manager

Case Manager / PRN ( RN / RT / SW / LPN )

Hospice Clinical Team Manager (RN Required)

Associate Medical Director

Hospital - Clinical Pharmacist Specialist (Bone Marrow Transplant)

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