Top 38038 Plant and system operators, all other Jobs in Miami, Fl

Care Review Clinician (RN) - Remote in FL
Molina Healthcare, Inc. —Miami, FL
- $26.41 - $51.49 an hour
- Full-time
- Remote
- RN License
- Mid-level
- Critical & Intensive Care
- Health insurance
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
WFH Administrative Assistant
Qureos Inc —Miami, FL
- $40 - $100 an hour
- Full-time
- Remote
- Microsoft Excel
- Microsoft Outlook
- Mid-level
- Work from home
6h
Personal Assistant
Qureos Inc —Doral, FL
- $25 - $32 an hour
- Overtime
- Remote
- Google Workspace
- Research
- High school diploma or GED
- Paid training
- Paid holidays
2d
Courier
University of Miami —Miami, FL
- Overtime
- HIPAA
- High school diploma or GED
- Driver's License
- Health insurance
- Dental insurance
9d
Administrative Assistant
KW Property Management LLC —Miami, FL
- $28 an hour
- Full-time
- Research
- Office
- High school diploma or GED
Quick Apply
8d
Patient Transporter, Vascular Lab, Full-Time
University of Miami —Miami, FL
- Weekends as needed
- No experience needed
- High school diploma or GED
- Communication skills
- Health insurance
- Dental insurance
10d
Data Entry Assistant
Qureos Inc —Miami, FL
- $18 - $25 an hour
- Full-time
- Office
- Administrative experience
- Typing
Patient Disability Advocate
HCA Florida Kendall Hospital —Miami, FL
- Full-time
- Entry level
- Employee stock purchase plan
- Disability insurance
Quick Apply
9d
Payroll Clerk
Costco Wholesale Corporation —Miami, FL
- Office
- Driving
- US work authorization
- AD&D insurance
- Employee stock purchase plan
OR Assistant
HCA Florida Aventura Hospital —Aventura, FL
- PRN
- Surgery
- Radiology
- Entry level
- Employee stock purchase plan
- Disability insurance
Quick Apply
2d
Surgery Scheduler
Aventura Florida Heart & Vascular —Aventura, FL
- Full-time
- Surgery
- No experience needed
- No travel
- Employee stock purchase plan
- Disability insurance
Quick Apply
Elevator Apprentice
Clark Elevator Company —Miami, FL
- Up to $70,000 a year
- Full-time
- Hybrid work
- 18 years or older
- High school diploma or GED
- Driver's License
- Relocation assistance
- Health insurance
Quick Apply
10d
Patient Transport Technician (Part Time, Days)
Nicklaus Children's Hospital —Miami, FL
- Part-time
- Hospital
- Maintenance
- High school diploma or GED
Assistant Property Manager
KW Property Management LLC —Miami, FL
- $90,000 a year
- Weekends as needed
- Spanish
- Mid-level
- Office
Quick Apply
11d
Warehouse Welcome Center Clerks 1st Shift
Ryder —Opa-locka, FL
- $22 an hour
- Full-time
- High school diploma or GED
- 1 year
- Entry level
- Paid training
- Health insurance
7d
Airport Record Center Clerk 2
Miami-Dade County —Miami-Dade County, FL
- $37,820.59 - $62,745.25 a year
- Full-time
- Mid-level
- High school diploma or GED
- Ability to lift 50 pounds
7d
Patient Finance Specialist, Full-Time, Days
Jackson Health —Miami, FL
- Full-time
- Inpatient
- High school diploma or GED
- Bachelor's degree
Quick Apply
11d
Surgery Scheduler
HCA Florida Neurosurgical Specialists —Miami, FL
- Full-time
- Surgery
- Mid-level
- Employee stock purchase plan
- Disability insurance
Quick Apply
Surgery Scheduler
HCA Florida Miami-Dade Surgical Specialists —Coral Gables, FL
- Full-time
- Surgery
- Mid-level
- Employee stock purchase plan
- Disability insurance
Quick Apply

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plant and system operators, all other jobs near miami, fl

Care Review Clinician (RN) - Remote in FL

Molina Healthcare, Inc. -
Miami, FL

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

plant and system operators, all other jobs in miami, fl

Care Review Clinician (RN) - Remote in FL

Care Review Clinician (RN) - Remote in FL

WFH Administrative Assistant

Personal Assistant

Courier

Administrative Assistant

Patient Transporter, Vascular Lab, Full-Time

Data Entry Assistant

Patient Disability Advocate

Payroll Clerk

OR Assistant

Surgery Scheduler

Elevator Apprentice

Patient Transport Technician (Part Time, Days)

Assistant Property Manager

Warehouse Welcome Center Clerks 1st Shift

Airport Record Center Clerk 2

Patient Finance Specialist, Full-Time, Days

Surgery Scheduler

Surgery Scheduler

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