Top 26 Utilization review nurse Jobs in Orange Park, Fl

Care Review Clinician, Specialty Therapist (Occupational / Physical / Speech) - REMOTE from Florida
Molina Healthcare —Jacksonville, FL
- $26.41 - $51.49 an hour
- Full-time
- Remote
- Physical & Rehabilitation Medicine
- Mid-level
- Physical Therapy License
- Health insurance
PT UTILIZATION REVIEW COORDINATOR
River Point Behavioral Health —Jacksonville, FL
- $26 - $37 an hour
- Part-time
- Background check
- RN License
- Computer literacy
- 401(k) matching
Utilization Management Nurse, PRN, Downtown
Baptist Health —Jacksonville, FL
- PRN
- Nursing
- Mid-level
- Office
Quick Apply
Utilization Management Reviewer
Mental Health Resource Center —Jacksonville, FL
- Full-time
- Background check
- Nursing
- Psychiatry
- Paid holidays
- Disability insurance
Quick Apply
Case Manager| Case Management| Variable |PRN
UF Health —Jacksonville, FL
- Per diem
- Master of Social Work
- Nursing
- RN License
Case Manager, University Inpatient Hospital, Full-time
BROOKS REHABILITATION —Jacksonville, FL
- Full-time
- Master of Social Work
- Experience working with individuals with disabilities
- Hospital
- Paid time off
- Employee discount
Quick Apply
2d
BPO Clinical Review Specialist
NTT Ltd —Jacksonville, FL
- $76,000 a year
- Background check
- RN License
- Pass drug screening
- Health savings account
- AD&D insurance
2d
Utilization Specialist, Remote, Oasis & Coding Certs Required
Concierge Home Care —Jacksonville, FL
- $65,000 - $85,000 a year
- Full-time
- Remote
- Background check
- RN License
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
3d
Care Review Clinician (BH Licensed) - Remote in FL
Molina Healthcare —Jacksonville, FL
- $26.41 - $51.49 an hour
- Full-time
- Remote
- LMFT
- Licensed Clinical Social Worker
- Mid-level
- Health insurance
Discharge Planner - Per Diem
UF Health Rehabilitation Hospital - North —Jacksonville, FL
- Weekends as needed
- Hospital
- Inpatient
- Mid-level
- Opportunities for advancement
Case Manager, Transitional Living-PRN
Brooks Rehabilitation —Jacksonville, FL
- Extended hours
- Master of Social Work
- Experience working with individuals with disabilities
- Hospital
Quick Apply
Case Manager, Bartram Inpatient Hospital, PRN
Brooks Rehabilitation —Jacksonville, FL
- PRN
- Master of Social Work
- Experience working with individuals with disabilities
- Hospital
Quick Apply
Medical Case Manager I
CorVel Corporation —Jacksonville, FL
- $63,739 - $110,701 a year
- Full-time
- Remote
- Nursing
- RN License
- Computer literacy
- Health savings account
- Disability insurance
Quick Apply
BPO Clinical Review Senior Specialist
NTT Ltd —Jacksonville, FL
- $81,120 a year
- Background check
- Pass drug screening
- Research
- Health savings account
- AD&D insurance
2d
Case Manager, Bartram Inpatient Hospital, PRN (1276)
Brooks Rehabilitation —Jacksonville, FL
- PRN
- Master of Social Work
- Experience working with individuals with disabilities
- Hospital
Registered Nurse Case Manager (1099) – Jacksonville, FL
The IMA Group —Jacksonville, FL
- No weekends
- Hybrid work
- Bilingual
- Nursing
- RN License
- Flexible schedule
Quick Apply
Case Manager, Transitional Living-PRN (1738)
Brooks Rehabilitation —Jacksonville, FL
- Extended hours
- Master of Social Work
- Skilled nursing facility
- Experience working with individuals with disabilities
Home Health Clinical Manager
Centerwell —Orange Park, FL
- Full-time
- CPR Certification
- Nursing
- RN License
- Paid parental leave
- Paid holidays
Team Manager Home Care
VITAS Healthcare —Jacksonville, FL
- Full-time
- RN License
- Mid-level
- Bachelor's degree
- Disability insurance
- Health insurance
Quick Apply
11d
Autonomous Family Nurse Practitioner (Part time to Full time)
Endeavor Health Center —Saint Johns, FL
- $70 an hour
- Part-time
- Hybrid work
- Medication administration
- Patient monitoring
- Physical & Rehabilitation Medicine
- Flexible schedule
Quick Apply
6d

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utilization review nurse jobs near orange park, fl

Care Review Clinician, Specialty Therapist (Occupational / Physical / Speech) - REMOTE from Florida

Molina Healthcare -
Jacksonville, FL

Apply Now

Job Details

Full-time
$26.41 - $51.49 an hour

Benefits

Health insurance

Qualifications

Productivity software

Full Job Description

Job Summary

Provides support for member services review assessment activities for a specific area of specialty. Responsible for ensuring that services are medically necessary, align with established clinical guidelines, insurance policies, and regulations, and that members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. Must reside in Florida.

Essential Job Duties

Analyzes clinical service requests from members and 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, and presents them in a consistent and efficient manner.
Requests additional information from members or providers as needed.
Makes member referrals to other clinical programs as appropriate.
Collaborates with multidisciplinary teams to promote the Molina care model.
Adheres to applicable utilization management policies and procedures.

Required Qualifications

At least 2 years experience in a hospital acute care, inpatient review, prior authorization, nursing, and/or managed care setting, or equivalent combination of relevant education and experience.
Occupational Therapist (OT), Physical Therapist (PT), Speech-Language Pathologist (SLP). 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.
Excellent verbal and written communication skills.
Microsoft Office suite/applicable software program(s) proficiency.

#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

Pay Range: $26.41 - $51.49 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Apply Now

Refine Your Search

utilization review nurse jobs in orange park, fl

Care Review Clinician, Specialty Therapist (Occupational / Physical / Speech) - REMOTE from Florida

PT UTILIZATION REVIEW COORDINATOR

Utilization Management Nurse, PRN, Downtown

Utilization Management Reviewer

Case Manager| Case Management| Variable |PRN

Case Manager, University Inpatient Hospital, Full-time

BPO Clinical Review Specialist

Utilization Specialist, Remote, Oasis & Coding Certs Required

Care Review Clinician (BH Licensed) - Remote in FL

Discharge Planner - Per Diem

Case Manager, Transitional Living-PRN

Case Manager, Bartram Inpatient Hospital, PRN

Medical Case Manager I

BPO Clinical Review Senior Specialist

Case Manager, Bartram Inpatient Hospital, PRN (1276)

Registered Nurse Case Manager (1099) – Jacksonville, FL

Case Manager, Transitional Living-PRN (1738)

Home Health Clinical Manager

Team Manager Home Care

Autonomous Family Nurse Practitioner (Part time to Full time)

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