Top 45 Utilization review nurse Jobs in Fort Lauderdale 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
6d
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
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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Clinical Documentation Integrity - Second Level Reviewer
University of Miami —Hialeah, FL
- Full-time
- Remote
- Nursing
- Medicine
- Microsoft Excel
- Health insurance
- Dental insurance
Concurrent Review Nurse
Leon Health —Miami, FL
- Spanish
- Nursing
- English
7d
UM Clinical Reviewer
Centers Plan for Healthy Living —Margate, FL
- Full-time
- RN License
- Communication skills
- Entry level
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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
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
13d
CLINICAL CARE MANAGER / RN
Catholic Hospice, Inc. —Fort Lauderdale, FL
- Weekends as needed
- Nursing
- RN License
- Nursing home
7d
Case Manager, Acute Care - Case Mgmt - PT Days - BHN
Broward Health —Deerfield Beach, FL
- Part-time
- Acute care
- Nursing
- RN License
Case Manager, Acute Care - Case Mgmt - Pool Days - BHMC
Broward Health —Fort Lauderdale, FL
- Day shift
- Acute care
- Nursing
- RN License
RN Case Manager
Cleveland Clinic —Weston, FL
- Full-time
- Acute care
- Nursing
- RN License
5d
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
Manager, Case Management
University of Miami —Miami, FL
- Full-time
- RN License
- Hospital
- Word processing
- Health insurance
- Dental insurance
Team Manager Home Care
VITAS Healthcare —Miramar, FL
- Full-time
- RN License
- Mid-level
- Bachelor's degree
- Disability insurance
- Health insurance
Quick Apply
13d
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
6d
Case Manager, Acute Care - Case Mgmt - Pool Days - BHCS
Broward Health —Coral Springs, FL
- Day shift
- Acute care
- Nursing
- RN License
5d
Hospice Clinical Team Manager (RN Required)
VITAS Healthcare —North Miami Beach, FL
- Part-time
- Nursing
- RN License
- Mid-level
- Disability insurance
- Health insurance
Quick Apply

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utilization review nurse jobs near fort lauderdale 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 fort lauderdale 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

Utilization Review Specialist

Clinical Documentation Integrity - Second Level Reviewer

Concurrent Review Nurse

UM Clinical Reviewer

Care Review Clinician (BH Licensed) - Remote in FL

Utilization Management Nurse

CLINICAL CARE MANAGER / RN

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

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

RN Case Manager

Home Health Wound Care RN

Manager, Case Management

Team Manager Home Care

RN Community Case Manager

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

Hospice Clinical Team Manager (RN Required)

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