Top 23 Utilization review nurse Jobs in Delray Beach, Fl

Utilization and Quality Nurse
FoundCare, Inc. —West Palm Beach, FL
- $70,000 - $90,000 a year
- Full-time
- Nursing
- Microsoft Excel
- Microsoft Outlook
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
Quick Apply
REGISTERED NURSE
THE TREATMENT CENTER —Lake Worth, FL
- Full-time
- CPR Certification
- Nursing
- Heavy lifting
Quick Apply
UM Clinical Reviewer
Centers Plan for Healthy Living —Margate, FL
- Full-time
- RN License
- Communication skills
- Entry level
Quick Apply
Case Manager, Acute Care - Case Mgmt - PT Days - BHN
Broward Health —Deerfield Beach, FL
- Part-time
- Acute care
- Nursing
- RN License
Case Manager - Acute Rehab Unit
Select Medical Rehabilitation - Palm Beach —Lake Worth, FL
- $45 an hour
- 8 hour shift
- Hospital
- Mid-level
- Rehabilitation center
- Dental insurance
- Paid time off
Quick Apply
CLINICAL CARE MANAGER / RN
Catholic Hospice, Inc. —Fort Lauderdale, FL
- Weekends as needed
- Nursing
- RN License
- Nursing home
7d
LICENSED PRACTICAL NURSE
THE TREATMENT CENTER —Lake Worth, FL
- Per diem
- CPR Certification
- Nursing
- Heavy lifting
Quick Apply
Registered Nurse-Emergency Services - LMC-FR
Health Care District of Palm Beach County —Palm Beach, FL
- Full-time
- Acute care
- CPR Certification
- Nursing
6d
Hospice Clinical Team Manager (RN Required)
VITAS Healthcare —Deerfield Beach, FL
- Full-time
- Nursing
- RN License
- Mid-level
- Disability insurance
- Health insurance
Quick Apply
Case Manager, Acute Care - Case Mgmt - Pool Days - BHCS
Broward Health —Coral Springs, FL
- Day shift
- Acute care
- Nursing
- RN License
5d
Team Manager Inpatient
VITAS Healthcare —Deerfield Beach, FL
- Full-time
- RN License
- Bachelor's degree
- Recruiting
- Disability insurance
- Health insurance
Quick Apply
5d
Infectious Disease ARNP/PA
Palm Beach ID Associates —Wellington, FL
- $125,000 - $140,000 a year
- Full-time
- Vital signs
- Hospital
- HIPAA
- Health insurance
- Dental insurance
Quick Apply
23h
Advanced Practice Registered Nurse
Boca Recovery Center —Pompano Beach, FL
- On call
- CPR Certification
- Nursing
- Psychiatry
- Disability insurance
- Health insurance
Quick Apply
Case Manager (LPN - Bilingual Spanish)
Sky Nurses —Boca Raton, FL
- $25 - $35 an hour
- Weekends as needed
- Spanish
- Nursing
- HIPAA
- Paid holidays
- Health insurance
Quick Apply
Appeals Professional III (Licensed Clinician)
Tanaq Support Services LLC —United States
- Full-time
- Remote
- Nursing
- RN License
- Writing skills
12d

Related jobs to explore

Based on your search for utilization review nurse

Per Diem RN - Independence Home Health
Independence Home Health —West Palm Beach, FL
Valid Registered Nurse (RN) license in Florida. Basic Life Support (BLS) certification is required. Strong clinical assessment and critical thinking skills.
$70 - $100 an hour
Quick Apply
Utilization Review Nurse
Oscar Health —Miami, FL
Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure…
$35.00 - $45.94 an hour
Quick Apply

Show more related jobs

Explore jobs in cities nearby

Check out jobs in cities near your current location, Columbus

Utilization Review Specialist - Autism
Nationwide Children's Hospital —Columbus, OH
Bachelor’s Degree in Social Work, Psychology, or related field, required. Documents all case reviews and maintains accurate records of all clinical activities…
Director of Nursing
North Central Correctional Complex —Marion, OH
Valid driver’s license in the state of Ohio with an acceptable driving record required, unless waived by management. Must possess current CPR certification.
$115,000 a year
11d

Show more jobs in cities nearby

I want to receive the latest job alert for utilization review nurse in delray beach, fl

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

utilization review nurse jobs near delray beach, fl

Utilization and Quality Nurse

FoundCare, Inc. -
West Palm Beach, FL

Apply Now

Job Details

Full-time
$70,000 - $90,000 a year

Qualifications

Collaborate with healthcare professionals
Medical performance measurement report preparation
Microsoft Excel
Microsoft Outlook
Utilization review
Electronic health records (EHR) management
RN License
Phone communication
Writing skills
CMS
HIPAA
English
Metrics Reporting
Quality reports
CMS regulatory compliance
Documentation tools
Clinical performance metrics
Utilization management
Public health
Resource utilization in healthcare
Health information regulatory compliance
Working with individuals from diverse cultural backgrounds
Disease state management
Management reporting
Clinical confidentiality policies
Associate's degree
Clinical data analysis
Associate Degree in Nursing
Healthcare performance metrics analysis
Quality assurance experience within healthcare

Full Job Description

Description:

PRIMARY PURPOSE:

To support utilization management, quality improvement, population health, and performance improvement activities within FoundCare, promoting high-quality, patient-centered, cost-effective care while ensuring compliance with HRSA, UDS, CMS, value-based care, and payer requirements. This position works collaboratively with providers, care teams, leadership, and community partners to identify care gaps, improve clinical outcomes, optimize resource utilization, and support quality initiatives focused on preventive care and chronic disease management.

ESSENTIAL JOB FUNCTIONS:

Promote the mission, vision, and values of FoundCare.

1. Quality Improvement

Coordinate and participate in the organization’s Quality Improvement (QI) and Performance Improvement (PI) programs.
Monitor and analyze quality metrics, including UDS, HEDIS, CMS quality measures, and value-based care indicators.
Conduct chart audits to evaluate compliance with clinical guidelines, documentation standards, and regulatory requirements.
Develop and implement quality improvement initiatives and corrective action plans.
Track provider performance and identify opportunities to improve quality outcomes.
Prepare quality reports and dashboards for leadership, the Quality Committee, and Board meetings.
Participate in root cause analyses and performance improvement activities.
Assist with accreditation, credentialing, and regulatory readiness activities.

2. Utilization Management

Review utilization data to identify trends in referrals, diagnostic testing, emergency department utilization, hospital admissions, and readmissions.
Collaborate with providers and care teams to promote appropriate utilization of health care services.
Monitor specialty referrals and follow-up outcomes.
Support care coordination and transitions of care for high-risk patients.
Participate in denial management and identify opportunities to improve payer compliance and reimbursement.

3. Population Health Management

Utilize EHR reports and population health tools to identify patients with care gaps and unmet health needs.
Support programs aimed at improving outcomes for patients with diabetes, hypertension, HIV, Hepatitis C, asthma, cardiovascular disease, and other chronic conditions.
Assist with patient registries and risk stratification initiatives.
Monitor quality measures and implement interventions to improve compliance rates.

4. Regulatory Compliance

Ensure compliance with HRSA Health Center Program requirements, UDS reporting standards, CMS regulations, payer requirements, and organizational policies.
Maintain accurate and timely documentation of quality and utilization activities.
Participate in internal and external audits.
Support implementation of evidence-based clinical practice guidelines.

5. Education and Collaboration

Educate clinical staff on quality initiatives, documentation requirements, clinical measures, and best practices.
Provide feedback to providers regarding quality performance and opportunities for improvement.
Participate in multidisciplinary meetings and quality committees.
Collaborate with leadership to develop strategies that improve patient outcomes and operational efficiency.
Perform other duties as assigned.

Requirements:

REQUIRED KNOWLEDGE, SKILLS AND ABILITIES:

Knowledge of FQHC operations and HRSA compliance requirements.
Understanding of health care quality metrics and performance improvement methodologies.
Familiarity with UDS, HEDIS, CMS Quality Measures, and value-based reimbursement models.
Knowledge of utilization review and population health principles.
Strong analytical, organizational, and problem-solving skills.
Ability to interpret clinical data and generate meaningful reports.
Ability to work independently and collaboratively within multidisciplinary teams.
Proficiency in Microsoft Office Suite, including Outlook, Word, and Excel, and the ability to navigate electronic health record systems.
Ability to communicate effectively in the English language, orally, in writing, and electronically.
Ability to review, understand, and apply concepts presented in training programs, conferences, and/or professional literature.
Ability to maintain confidentiality of all patient and organizational information in accordance with HIPAA regulations.
Ability to interact and work with diverse populations.
Ability to handle difficult situations involving patients, providers, or others, professionally.
Clear understanding that FoundCare provides information on educating individuals on safer sex practices which would include but not be limited to, exposure to explicit language, explicit printed material, and descriptions of explicit sexual activities as part of the agency’s mission in the prevention and transmission of HIV disease.

PHYSICAL REQUIREMENTS

Ability to endure prolonged periods of sitting, standing, and computer use in performance of job duties.
Ability to communicate effectively in person, by telephone, and electronically.
Use standard office equipment and technology, including computers, telephones, and clinical equipment and systems, in the course of daily duties.
Ability to lift and carry objects weighing 25 pounds or less.
Ability to travel to other FoundCare locations and perform job duties.
Ability to travel to other locations to attend meetings, workshops, and seminars, plus travel to other FoundCare departments and FoundCare conference rooms.

MINIMUM QUALIFICATIONS:

Associate Degree in Nursing required; Bachelor of Science in Nursing (BSN) preferred.
Current and unrestricted Registered Nurse (RN) license in the State of Florida.
Minimum of three (3) years of clinical nursing experience.
Experience in Quality Improvement, Utilization Management, Case Management, Population Health, Ambulatory Care, Managed Care, or FQHC settings preferred.
Experience with UDS reporting, HEDIS measures, and value-based care programs strongly preferred.
Certified Professional in Healthcare Quality (CPHQ) or Certified Case Manager (CCM) preferred.
This role is not eligible for visa sponsorship.

Apply Now

Refine Your Search

utilization review nurse jobs in delray beach, fl

Utilization and Quality Nurse

Utilization Review Specialist

REGISTERED NURSE

UM Clinical Reviewer

Case Manager, Acute Care - Case Mgmt - PT Days - BHN

Case Manager - Acute Rehab Unit

CLINICAL CARE MANAGER / RN

LICENSED PRACTICAL NURSE

Registered Nurse-Emergency Services - LMC-FR

Hospice Clinical Team Manager (RN Required)

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

Team Manager Inpatient

Infectious Disease ARNP/PA

Advanced Practice Registered Nurse

Case Manager (LPN - Bilingual Spanish)

Appeals Professional III (Licensed Clinician)

Related jobs to explore

Explore jobs in cities nearby

I want to receive the latest job alert for utilization review nurse in delray beach, fl

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected