Top 149 Prior authorization nurse Jobs in Florida

Utilization Review Nurse
Cobalt Benefits Group LLC —Orlando, FL
- $90,000 - $98,000 a year
- Full-time
- Remote
- Nursing
- Microsoft Excel
- Microsoft Outlook
- Health savings account
- AD&D insurance
Quick Apply
Registered Nurse - Inpatient Medical, Nights - RN
Mayo Clinic —Jacksonville, FL
- Weekends as needed
- Nursing
- RN License
- Hospital
- Health savings account
- Health insurance
3d
Registered Nurse - Transplant and Medical, Nights - RN
Mayo Clinic —Jacksonville, FL
- Weekends as needed
- Nursing
- RN License
- Hospital
- Health savings account
- Health insurance
9d
Infusion Nurse
Confidential —Avon Park, FL
- $25 - $30 an hour
- Full-time
- Nursing
- Blood sampling
- RN License
- Health savings account
- Health insurance
Quick Apply
Medical Assistant/LPN Bilingual
Metro Healthy Communities —Tampa, FL
- From $22 an hour
- Full-time
- Background check
- Spanish
- CPR Certification
- Wellness program
- Mileage reimbursement
Quick Apply
Registered Nurse - Neuro/Transplant ICU , Part-Time Nights - RN
Mayo Clinic —Jacksonville, FL
- Part-time
- Nursing
- RN License
- BLS Certification
- Health savings account
- Health insurance
10d
Registered Nurse - Inpatient Medical, Part-Time Nights - RN
Mayo Clinic —Jacksonville, FL
- Part-time
- Nursing
- RN License
- Hospital
- Health savings account
- Health insurance
9d
Registered Nurse - Hematology/Oncology and Medical, Part-Time - RN
Mayo Clinic —Jacksonville, FL
- Part-time
- Nursing
- RN License
- Hospital
- Health savings account
- Health insurance
1d
Registered Nurse -Neuro/Transplant ICU Part-Time - RN
Mayo Clinic —Jacksonville, FL
- Part-time
- Nursing
- RN License
- BLS Certification
- Health savings account
- Health insurance
10d
Registered Nurse - Hematology/Oncology and Medical, Nights - RN
Mayo Clinic —Jacksonville, FL
- Weekends as needed
- Nursing
- RN License
- Hospital
- Health savings account
- Health insurance
9d
Registered Nurse - Hematology/Oncology and Medical, Part-Time Nights - RN
Mayo Clinic —Jacksonville, FL
- Part-time
- Nursing
- RN License
- Hospital
- Health savings account
- Health insurance
Registered Nurse - Inpatient Float Pool, Weekends Only - RN
Mayo Clinic —Jacksonville, FL
- Weekends only
- Nursing
- Float pool
- RN License
- Health savings account
- Health insurance
8d
Registered Nurse - Inpatient Float Pool, Weekends Only Nights - RN
Mayo Clinic —Jacksonville, FL
- Weekends only
- Nursing
- Float pool
- RN License
- Health savings account
- Health insurance
8d
Registered Nurse - Inpatient Medical, Part-Time - RN
Mayo Clinic —Jacksonville, FL
- Part-time
- Nursing
- RN License
- Hospital
- Health savings account
- Health insurance
Registered Nurse - Inpatient Float Pool, Part-Time Weekends Only Nights - RN
Mayo Clinic —Jacksonville, FL
- Weekends only
- Nursing
- Float pool
- RN License
- Health savings account
- Health insurance
8d
Registered Nurse - Abdominal Transplant Operating Room - RN
Mayo Clinic —Jacksonville, FL
- Weekends as needed
- Nursing
- Surgery
- RN License
- Health savings account
- Health insurance
8d
Registered Nurse
Respiratory Critical Care and Sleep Medicine Associates, Inc. —Jacksonville, FL
- $27 - $33 an hour
- Full-time
- Background check
- Nursing
- RN License
- Health insurance
- Dental insurance
Quick Apply
5d
Registered Nurse - Night Shift Inpatient Opportunities – RN
Mayo Clinic —Jacksonville, FL
- Weekends as needed
- Nursing
- RN License
- Hospital
- Health insurance
- Dental insurance
Quick Apply
2d
LPN Licensed Practical Nurse
JAI HO LLC —Palm Bay, FL
- $20 - $26 an hour
- Full-time
- CPR Certification
- BLS Certification
- LPN
Quick Apply
1d
Licensed Practical Nurse
Priority Care Staffing —Daytona Beach, FL
- $35 an hour
- Overtime
- Background check
- CPR Certification
- Skilled nursing facility
- Disability insurance
- Health insurance
Quick Apply

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Utilization Review Nurse

Cobalt Benefits Group LLC -
Orlando, FL

Quick Apply

Job Details

Full-time
$90,000 - $98,000 a year

Benefits

Health savings account
AD&D insurance
Paid holidays
Disability insurance
Health insurance
Dental insurance
Flexible spending account
Tuition reimbursement
Vision insurance

Qualifications

Computer operation
Microsoft Excel
Microsoft Outlook
RN License
Patient care
Desktop applications
Resource utilization in healthcare

Full Job Description

Description:

Join our team at Cobalt Benefits Group and start an exciting new career in employee benefits solutions. As a Utilization Review Nurse (UR Nurse), you’ll play an important role in helping us offer customized, self-funded insurance options to our clients and members.

The UR Nurse is responsible for reviewing clinical information to determine the medical necessity, appropriateness, and efficiency of healthcare services, procedures, and levels of care in accordance with established criteria, payer guidelines, and organizational policies. This role involves evaluating healthcare services and facilities under the provisions of applicable health benefit plans to ensure quality and cost-effective patient care.

The UR Nurse collaborates closely with intake staff, physicians, specialists, case managers, and other members of the care team to facilitate timely and effective care authorizations, transitions, and utilization determinations. Strong communication, clinical judgment, and attention to detail are essential to ensure services meet both clinical standards and benefit requirements.

Responsibilities

Perform utilization and concurrent reviews of inpatient cases using Milliman, Aetna, and BCBS criteria.
Conduct medical necessity reviews for services requiring prior authorization, applying utilization-specific criteria.
Request and evaluate clinical information needed to review requested services.
Discuss cases and determinations with healthcare professionals and physician reviewers.
Identify cases requiring intervention and collaborate with Case Managers as needed.
Maintain appropriate and accurate documentation, ensuring compliance with audit standards.
Participate in team meetings, educational sessions, and related activities.
Review medical claims and pre-determinations for medical necessity and appropriateness.
Identify opportunities for process improvement and enhance communication among departments.
Consult with Physician Reviewers for complex or challenging cases.

Requirements:

Current, unrestricted RN license (State license required).
Minimum 3 years of clinical nursing experience.
Minimum 1 year of Utilization Management (UM) or Utilization Review (UR) experience.
Strong analytical, critical thinking, and problem-solving skills.
Proficiency in Microsoft Office Suite (Excel, Word, Outlook) and familiarity with utilization management systems.
Excellent verbal and written communication skills, with the ability to interact effectively with internal and external stakeholders.
Strong organizational and time management skills, with the ability to handle multiple priorities independently.

Preferred Qualifications

Experience with Milliman or Aetna criteria.
Background in healthcare administration, medical necessity determination, or benefits management.
Experience in data interpretation and medical trend analysis.

Work Environment & Physical Demands

Prolonged periods of sitting may be required.
Regular use of a computer, keyboard, and mouse is necessary; reasonable accommodations will be provided upon request.
Employees should ensure an ergonomically appropriate desk and chair setup.
Comfort with being on camera for virtual meetings (e.g., Microsoft Teams)

Benefits

After successfully completing a waiting period, eligible full-time employees have access to our comprehensive benefits package, including:

Fantastic medical, dental, and vision insurance*
Twice annual employer HSA contributions, covering 50% of the HDHP plan’s annual deductible!
Company-provided Basic Life and AD&D
Company-paid Short-Term and Long-Term Disability**
Flexible Spending Accounts*
401(k) Retirement Plan with up to a 6% employer match** (100% fully vested after 3 years)
10+ paid holidays
Half-day Summer Fridays
Generous paid vacation and sick time
Annual paid Volunteer Day
Annual Tuition reimbursement
Annual Health and Wellness reimbursement
Lots of fun company events

Benefit Waiting Period Notes: *60-day waiting period, **90-day waiting period

Who We Are

As a trusted Third-Party Administrator (TPA) specializing in self-funded benefit plans, Cobalt Benefits Group (CBG) is committed to helping employers find high-quality coverage at a cost they can afford. We administer self-funded insurance benefits through our four companies: EBPA, Blue Benefit Administrators of Massachusetts, CBA Blue, and Great Bay Administrators. With over 30 years of experience and a dedicated team of nearly 300 employees, we work collaboratively to build customized self-funded health plans, manage claim payments and disputes, and administer other specialized programs such as FSAs, HSAs, COBRA, and retiree billing. Cobalt Benefits Group is one of the fastest growing TPA's in the country and the fastest growing in New England. Join us as we match employers across our region with the right solutions for their employee benefit needs. To learn more about working at CBG, visit www.cobaltbenefitsgroup.com/careers.

Quick Apply

Refine Your Search

prior authorization nurse jobs in florida

Utilization Review Nurse

Registered Nurse - Inpatient Medical, Nights - RN

Registered Nurse - Transplant and Medical, Nights - RN

Infusion Nurse

Medical Assistant/LPN Bilingual

Registered Nurse - Neuro/Transplant ICU , Part-Time Nights - RN

Registered Nurse - Inpatient Medical, Part-Time Nights - RN

Registered Nurse - Hematology/Oncology and Medical, Part-Time - RN

Registered Nurse -Neuro/Transplant ICU Part-Time - RN

Registered Nurse - Hematology/Oncology and Medical, Nights - RN

Registered Nurse - Hematology/Oncology and Medical, Part-Time Nights - RN

Registered Nurse - Inpatient Float Pool, Weekends Only - RN

Registered Nurse - Inpatient Float Pool, Weekends Only Nights - RN

Registered Nurse - Inpatient Medical, Part-Time - RN

Registered Nurse - Inpatient Float Pool, Part-Time Weekends Only Nights - RN

Registered Nurse - Abdominal Transplant Operating Room - RN

Registered Nurse

Registered Nurse - Night Shift Inpatient Opportunities – RN

LPN Licensed Practical Nurse

Licensed Practical Nurse

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