Top 238 Nurse case managers Jobs in Mount Dora, Fl

Utilization Management Nurse Reviewer LPN (Work at Home for FL residents only)
Coastal Care Services, Inc. —Florida
- From $28 an hour
- Full-time
- Remote
- Microsoft Word
- Background check
- Spanish
- Disability insurance
- Health insurance
Quick Apply
13d
Clinical Documentation Integrity Specialist
AdventHealth Minneola —Minneola, FL
- $72,786.83 - $135,385.27 a year
- Full-time
- Background check
- Nursing
- Medicine
- Paid parental leave
- Disability insurance
3d
Nurse Case Management - Orlando, FL
Paradigm Corp —Orlando, FL
- $82,000 - $92,000 a year
- Full-time
- Hybrid work
- RN License
- Experience working with individuals with disabilities
- Hospital
- Mileage reimbursement
- Health savings account
Supervisor, Healthcare Services
Molina Healthcare —Mid Florida, FL
- $66,456 - $129,590 a year
- Full-time
- LMFT
- LVN
- RN License
- Health insurance
Case Manager|Case Management| Day | Full Time
UF Health —Leesburg, FL
- 8 hour shift
- Nursing
- RN License
- English
Transition of Care Coach (RN) - FL
Molina Healthcare —Orlando, FL
- $26.41 - $51.49 an hour
- Full-time
- Hybrid work
- Acute care
- Up to 50% travel
- RN License
- Health insurance
Clinical Documentation Specialist III
AdventHealth Winter Garden —Winter Garden, FL
- $72,786.83 - $135,385.27 a year
- Full-time
- Background check
- Nursing
- Medicine
- Paid parental leave
- Disability insurance
3d
Patient Management Nurse
Aegis Medical Group —Leesburg, FL
- Full-time
- HIPAA
- Mid-level
9d
Registered Nurse Manager - RN Care Management
AdventHealth Winter Garden —Winter Garden, FL
- $72,189.82 - $134,259.75 a year
- Full-time
- Background check
- Inpatient
- Mid-level
- Paid parental leave
- Disability insurance
Trainer, Clinical Services
Molina Healthcare —Orlando, FL
- $29.05 - $56.64 an hour
- Full-time
- Classroom
- Nursing
- RN License
- Health insurance
RN Workers Compensation Case Manager
AdventHealth Corporate —Altamonte Springs, FL
- $68,132.50 - $119,520.35 a year
- Full-time
- Background check
- Nursing
- RN License
- Paid parental leave
- Disability insurance
9d
Registered Nurse RN Transition Specialist Division Team-Float
AdventHealth Orlando Support —Orlando, FL
- $31.55 - $58.69 an hour
- Full-time
- Background check
- Nursing
- Microsoft Excel
- Paid parental leave
- Disability insurance
Nurse Case Manager- Complex Care (Onsite) (Registered Nurse)
Chen Medical Associates —Orlando, FL
- $36.90 - $52.70 an hour
- Full-time
- Nursing
- Microsoft Outlook
- RN License
- Opportunities for advancement
Integrated Care Coach
Centerwell —Clermont, FL
- $53,700 - $72,600 a year
- Overtime
- Spanish
- LVN
- RN License
- Paid jury duty
- Paid parental leave
Care Manager
Assisting Hands of The Villages —Lady Lake, FL
- $26 - $34 an hour
- Full-time
- Management
- RN License
- HIPAA
- Health insurance
- Flexible schedule
Quick Apply
Patient Care Coordinator, Home Health
Centerwell —DeLand, FL
- $59,300 - $80,900 a year
- Full-time
- Nursing
- LVN
- RN License
- Paid parental leave
- Paid holidays
Case Management RN Float Pool
AdventHealth Orlando Support —Orlando, FL
- $32.76 - $57.47 an hour
- Weekends as needed
- Background check
- CPR Certification
- Nursing
- Paid parental leave
- Disability insurance
Social Worker MSW Hospice
AdventHealth Home Health and Hospice —Altamonte Springs, FL
- $44,825.02 - $91,705.34 a year
- Full-time
- Background check
- CPR Certification
- Microsoft Excel
- Paid parental leave
- Disability insurance
13d
Case Manager - PRN Days | Orange City Rehab
PAM Health, LLC —Orange City, FL
- PRN
- RN License
- Hospital
- BLS Certification
- Opportunities for advancement
- Referral program
Quick Apply
14d
RN Care Manager, OHARI
Orlando Health —Ocoee, FL
- Full-time
- Nursing
- RN License
- Hospital
- Paid parental leave
- Loan repayment program

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nurse case managers jobs near mount dora, fl

Utilization Management Nurse Reviewer LPN (Work at Home for FL residents only)

Coastal Care Services, Inc.
Florida

Quick Apply

Job Details

Full-time
From $28 an hour
13 days ago

Benefits

Disability insurance
Health insurance
Dental insurance
Paid time off
Work from home
Vision insurance
Employee discount
Life insurance

Qualifications

Microsoft Word
Spanish
Customer communication
Teamwork
Microsoft Outlook
Medicare
Interpersonal skills
Customer service
Managed care organization experience
Writing skills
English
High school diploma or GED
Medicaid health insurance
Pre-authorization review for utilization management
Utilization management
Resource utilization in healthcare
Concurrent review in utilization management
Medicaid
LPN
Home health
Home health agency experience

Full Job Description

LPN Utilization Management Nurse Reviewer

Miami, FL (Work from Home position for FL residents only)

Currently seeking an LPN FL licensed Utilization Management Nurse Reviewer for a great opportunity working from home at a dynamic healthcare organization based in Miami, FL area. Work Schedule 10am to 7pm, working every other Sunday with a weekday off for a total of 5 days a week. The ideal candidate will possess 3 years of experience managing the treatment plan and utilization for members receiving Home Health Care / Infusion Services and Durable medical equipment and supplies.

JOB SUMMARY:

Manages the treatment plan and utilization for all members receiving Home Health Care / Infusion Services and Durable medical equipment and supplies. Conducts the review process for those requests that appear not to be medically necessary; facilitates, coordinates and evaluates the ongoing care of a specific caseload of patients to collaborate with physicians, the patient and the family to assure cost-effective, high quality, appropriate home care for the patient during the entire episode of illness and for post discharge services and to monitor and evaluate patient outcomes, including self-management.

ESSENTIAL JOB FUNCTIONS:

Duties of the Utilization Review Nurse / Home Health Case Manager include but are not limited to:

o Receive updated orders and medical information from all referral sources, i.e. Hospitals, Physician’s offices, Skilled Nursing Facilities, Rehabilitation Centers, Health Plans, PHOs, CM Departments, Home Health Agencies and others.

o Perform clinical review, to ensure that pre-established medical necessity/appropriateness criteria are met.

o Refer reviews that do not meet coverage criteria to Medical Director and/or Health Plan.

o Review and evaluates home health admission for clinical appropriateness of the continued care.

o Identifies and engages patients in appropriate care.

o Develop coordinated, collaborative care plans with all involved providers.

o Perform reviews telephonically using the member’s medical records, discussion with the member’s physician and/or discussion with Home health agency staff.

o Facilitate timely discharges and transfers based on individual needs and care requirements

o Educate patients to help them understand their health choices and assist them in making informed decisions about their health care.

o Serve as information resource and liaison to patients, health care professionals, facilities, health plan representatives, care givers, agencies and family members.

o Monitor cost-effective use of resources.

o Monitor health care service delivery and utilization according to the plan of care

o Provide authorizations and notifications in a timely manner.

o Maintain/update active patient list

o Document and resolve first line patient treatment plan.

o Prepare concise clinically based rationales that support clinical criteria such as: CMS, Medicaid, Health Plan Benefits, and InterQual

o Maintain a working knowledge of, and adheres to applicable federal/state regulations including but not limited to, laws related to patient confidentiality, release of information, and HIPAA

o Input the pertinent information and authorization into the appropriate software

o Maintain files.

o Participate in department meetings and in-services

PHYSICAL REQUIREMENTS:

1. The physical activities of this position involve fingering, grasping, talking, hearing, repetitive motions that may include the wrists, hands and/or fingers, sedentary work.

2. The physical demands of this position involve sedentary work constantly remaining in a stationary position, sitting for prolonged periods of time.

3. It may include exerting up to 10 pounds of force occasionally to lift, carry, push, pull or otherwise move objects, including the human body.

4. Constantly communicating with others to express or exchange information by means of the spoken word and/or in writing.

5. The visual acuity requirements of this position involve (including color, depth perception, and field of vision) to have close visual acuity to perform an activity such as: preparing and/or analyzing data and figures; constantly viewing a computer terminal and/or extensive reading.

6. Working Conditions of this position involve constant typical office or administrative work. No adverse environmental conditions expected.

MINIMUM QUALIFICATIONS:

1. LPN license required

2. 3 years of Home Health Managed Care experience.

3. Medicare/Medicaid Managed Care experience

4. Experience with InterQual (IQ), Milliman Care Guidelines (MCG) or other criteria used to determine medical necessity preferred.

5. Possess excellent customer service skills.

6. Bilingual (English/Spanish) preferred.

7. Effective verbal and written communication skills.

8. Proficient in MS Outlook, MSWord and Internet Explorer.

9. WAH (Work at Home) Requirements - Must have reliable high-speed internet. Minimum standard speed for optimal performance of 10 x 1 (10mbs download x 1mbs upload) required. Must have a separate private workspace / desk area designated for home office to ensure absolute and continuous privacy while at work.

The company is an Equal Opportunity Employer, in accordance with State and federal law. Coastal does not discriminate in employment opportunities or practices on the basis of race, color, religion, sex, national origin, age, disability, sexual orientation or any other characteristic protected by law. Opportunity is provided to all employees based on qualifications and job requirements.

We are a Drug-Free Work Place, we test for THC. This position is contingent upon completion and passing of a drug screening, verification of previous employment and a Level 2 Criminal Background check (please refer to the following website for more information and details on the Florida Care Provider Background Screening Clearinghouse: https://info.flclearinghouse.com.

No relocation/Local candidates only (FL state)

Job Type: Full-time

Pay: From $28.00 per hour

Benefits:

Dental insurance
Disability insurance
Employee discount
Health insurance
Life insurance
Paid time off
Vision insurance

Application Question(s):

What are your minimum salary expectations per hour?
Are you willing to undergo a background check, in accordance with local law/regulations?
Are you able to work holiday rotation once a year?
Are you able to work 10:00am-7:00pm and work every other Sunday with a weekday off; working 5 days total/week?

Education:

High school or equivalent (Preferred)

Experience:

InterQual, Milliman Care Guidelines or other similar: 1 year (Preferred)
home health and managed care: 1 year (Required)
Utilization review / medical necessity: 1 year (Required)
concurrent and retrospective UM related functions: 1 year (Required)

Language:

English and Spanish fluently (Preferred)

License/Certification:

LPN clear and active for the state of FL (Required)

Work Location: Remote

Quick Apply

Refine Your Search

nurse case managers jobs in mount dora, fl

Utilization Management Nurse Reviewer LPN (Work at Home for FL residents only)

Clinical Documentation Integrity Specialist

Nurse Case Management - Orlando, FL

Supervisor, Healthcare Services

Case Manager|Case Management| Day | Full Time

Transition of Care Coach (RN) - FL

Clinical Documentation Specialist III

Patient Management Nurse

Registered Nurse Manager - RN Care Management

Trainer, Clinical Services

RN Workers Compensation Case Manager

Registered Nurse RN Transition Specialist Division Team-Float

Nurse Case Manager- Complex Care (Onsite) (Registered Nurse)

Integrated Care Coach

Care Manager

Patient Care Coordinator, Home Health

Case Management RN Float Pool

Social Worker MSW Hospice

Case Manager - PRN Days | Orange City Rehab

RN Care Manager, OHARI

I want to receive the latest job alert for nurse case managers in mount dora, fl

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