Top 6403 Remote] Jobs in Florida

Care Review Clinician (RN) - Remote in FL
Molina Healthcare, Inc. —Florida
- $26.41 - $51.49 an hour
- Full-time
- Remote
- RN License
- Mid-level
- Critical & Intensive Care
- Health insurance
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
Behavioral Scientist - AI Trainer
DataAnnotation —Melbourne, FL
- $40 - $60 an hour
- Part-time
- Remote
- Computer Science
- English
- Mid-level
- Flexible schedule
Quick Apply
Certified Outpatient Coder (COC) - AI Trainer
DataAnnotation —Florida
- From $20 an hour
- Overtime
- Remote
- Medicine
- Writing skills
- English
Quick Apply
CDI Specialist (Clinical Documentation Improvement) - AI Trainer
DataAnnotation —Florida
- From $20 an hour
- Overtime
- Remote
- Medicine
- Writing skills
- English
Quick Apply
Remote Live Chat Customer Support Representative
Aviation Success LLC —Florida
- $34.03 - $38.93 an hour
- Part-time
- Remote
- Bilingual
- Computer literacy
- Typing
- Paid training
- Relocation assistance
Quick Apply
2d
Business Solutions Consultant (Acumatica, Real Estate) – Remote
Anton Systems, Inc. —Florida
- $100,000 - $130,000 a year
- Full-time
- Remote
- Background check
- Software troubleshooting
- ERP systems
- Health insurance
- 401(k)
Quick Apply
Healthcare CDI Specialist
The CSI Companies —Jacksonville, FL
- Contract
- Remote
- Mid-level
- Discharge planning
- Medical terminology
Quick Apply
4d
Remote ACA & Ancillaries Opportunity – Leads & Training Provided!
Ideal Concepts —Florida
- $60,000 - $90,000 a year
- Contract
- Remote
- Entry level
- Work from home
Quick Apply
1d
Inpatient Coding Specialist, Fully Remote, $5000 Bonus,CCS or RHIT certified
Baptist Health South Florida —Florida
- $29.41 - $38.23 an hour
- Remote
- Microsoft Word
- Mid-level
- High school diploma or GED
- Wellness program
- Continuing education credits
Inbound Sales Consultant - FL
Viking Cruises US —Florida
- $80,000 - $190,000 a year
- Weekends as needed
- Remote
- Microsoft Outlook
- 5 years
- Senior level
- Paid training
- Employee stock purchase plan
Quick Apply
Remote Account Executive Opportunity
ReminderMedia —Florida
- $65,000 - $125,000 a year
- Full-time
- Remote
- English
- Mid-level
- High school diploma or GED
- Health insurance
- Dental insurance
Quick Apply
Remote Insurance Sales Representative
The Butler Agency —Orlando, FL
- $75,000 - $150,000 a year
- Full-time
- Remote
- Communication skills
- Entry level
- Under 1 year
- Opportunities for advancement
- Flexible schedule
5d
Collections Representative
Contemporary Staffing —Jacksonville, FL
- $16 an hour
- Temporary
- Remote
- Mid-level
- High school diploma or GED
- Analysis skills
Quick Apply
14d
Content Writer - AI Trainer
DataAnnotation —Bradenton, FL
- $25 - $30 an hour
- Part-time
- Remote
- Writing skills
- English
- Research
Quick Apply
Insurance Agent - Flexible Schedule
Simmons Financial Agency —Tampa, FL
- $50,000 - $175,000 a year
- Choose your own hours
- Remote
- No experience needed
- Communication skills
- Entry level
- Dental insurance
- Vision insurance
Quick Apply
System Administrator
CAI —Fort Myers, FL
- $60,000 - $660,000 a year
- Full-time
- Remote
- Mid-level
- Commercial
- Health insurance
- Dental insurance
Insurance Agent - Flexible Schedule
Simmons Financial Agency —Saint Petersburg, FL
- $50,000 - $175,000 a year
- Choose your own hours
- Remote
- No experience needed
- Communication skills
- Entry level
- Dental insurance
- Vision insurance
Quick Apply
Patient Services Specialist - Nurse
Serva Health LLC —Florida
- From $65,000 a year
- Weekends as needed
- Remote
- Background check
- Spanish
- Nursing
- Health insurance
- Dental insurance
Quick Apply
Career Services Advisor
UMA Education —Tampa, FL
- $20 an hour
- Weekends as needed
- Remote
- 18 years or older
- Microsoft Excel
- English
- Health savings account
- Disability insurance
Quick Apply

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Care Review Clinician (RN) - Remote in FL

Molina Healthcare, Inc. -
Florida

Apply Now

Job Details

Full-time
$26.41 - $51.49 an hour

Benefits

Health insurance

Qualifications

Inpatient experience
RN License
Managed care organization experience
Acute care facility experience
Pre-authorization review for utilization management
Productivity software

Full Job Description

JOB DESCRIPTION

Must reside in Florida

Job Summary

Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - 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 to ensure 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 (MDs) and presents them 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 the Molina care model.
Adheres to utilization management (UM) policies and procedures.

Required Qualifications

At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience.
Registered Nurse (RN). License must be active and unrestricted in state of practice.
Ability to prioritize and manage multiple deadlines.
Excellent organizational, problem-solving and critical-thinking skills.
Strong written and verbal communication skills.
Microsoft Office suite/applicable software program(s) proficiency.

Preferred Qualifications

Certified Professional in Healthcare Management (CPHM).
Recent hospital experience in an intensive care unit (ICU) or emergency room.

Utilization Management (UM) experience highly preferred.

#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

remote] jobs in florida

Care Review Clinician (RN) - Remote in FL

Care Review Clinician (BH Licensed) - Remote in FL

Behavioral Scientist - AI Trainer

Certified Outpatient Coder (COC) - AI Trainer

CDI Specialist (Clinical Documentation Improvement) - AI Trainer

Remote Live Chat Customer Support Representative

Business Solutions Consultant (Acumatica, Real Estate) – Remote

Healthcare CDI Specialist

Remote ACA & Ancillaries Opportunity – Leads & Training Provided!

Inpatient Coding Specialist, Fully Remote, $5000 Bonus,CCS or RHIT certified

Inbound Sales Consultant - FL

Remote Account Executive Opportunity

Remote Insurance Sales Representative

Collections Representative

Content Writer - AI Trainer

Insurance Agent - Flexible Schedule

System Administrator

Insurance Agent - Flexible Schedule

Patient Services Specialist - Nurse

Career Services Advisor

I want to receive the latest job alert for remote] in florida

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