Top 240 Member services representative Jobs in Palm Bay 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
Member Service Representative (Melbourne Branch)
Community Credit Union of Florida —Melbourne, FL
- $23.92 - $26.58 an hour
- Full-time
- Word processing
- Computer literacy
- Writing skills
Quick Apply
9d
Member Services Representative
Planet Fitness - Eclipse Fitness Group —Melbourne, FL
- Part-time
- 18 years or older
- Computer literacy
- High school diploma or GED
- Health insurance
- 401(k)
Quick Apply
Member Service Representative (Viera West Branch)
Community Credit Union of Florida —Viera, FL
- $23.92 - $26.58 an hour
- Full-time
- Word processing
- Computer literacy
- Writing skills
Quick Apply
9d
Member Service Representative (Rockledge Branch)
Community Credit Union of Florida —Rockledge, FL
- $23.92 - $26.58 an hour
- Full-time
- Word processing
- Computer literacy
- Writing skills
Quick Apply
6d
FT or PT Medication Technician - 1st or 2nd Shifts
Palm Bay Memory Care —Palm Bay, FL
- $17 an hour
- Part-time
- Serving
- English
- Residential
- Paid holidays
- Disability insurance
Quick Apply
Customer Service Representative - State Farm Agent Team Member
Arty Pagan - State Farm Agent —Melbourne, FL
- $18 - $26 an hour
- Full-time
- Office
- Communication skills
- Entry level
- Paid time off
- Opportunities for advancement
Quick Apply
Patient Services Specialist II (Primary Care, Sebastian)
Nemours —Sebastian, FL
- Full-time
- Primary Care
- Mid-level
- High school diploma or GED
- 403(b) matching
- Health insurance
Customer Service Representative - State Farm Agent Team Member
Jeff Thummel - State Farm Agent —Palm Bay, FL
- $35,000 - $50,000 a year
- Full-time
- Office
- Children
- Communication skills
- Health insurance
- 401(k)
Quick Apply
Customer Relations Representative - State Farm Agent Team Member
Emilee Johnson - State Farm Agent —Melbourne, FL
- $55,000 - $75,000 a year
- Full-time
- Office
- Communication skills
- Entry level
- Health insurance
- Paid time off
Quick Apply
Crew Member
Moe's Southwest Grill —Melbourne, FL
- $15 - $20 an hour
- Part-time
- Ability to lift 50 pounds
- Quick service & fast food restaurant
- Communication skills
Quick Apply
Patient Service Representative - Dermatology + Plastic Surgery
Forefront Dermatology —Melbourne, FL
- Urgently hiring
- Surgery
- Computer literacy
- High school diploma or GED
- Profit sharing
- Health savings account
Customer Service Representative 1st shift + weekends
Nextech —Melbourne, FL
- $18 an hour
- Weekends as needed
- Typing
- Communication skills
- Entry level
- Opportunities for advancement
Melbourne - Teller
ELGA Credit Union —Melbourne, FL
- High school diploma or GED
- Typing
- 1 year
Quick Apply
Team Member
Pollo Tropical —West Melbourne, FL
- Part-time
- English
- Ability to lift 50 pounds
- Restaurant
Account Representative - State Farm Agent Team Member
Arty Pagan - State Farm Agent —Melbourne, FL
- $70,000 - $90,000 a year
- Full-time
- Office
- Communication skills
- Marketing
- Health insurance
- 401(k)
Quick Apply
JUVENILE PROBATION OFFICER - 80061674
The State of Florida —Melbourne, FL
- $3,530.02 a month
- Weekends as needed
- Microsoft PowerPoint
- School experience
- Clean driving record
5d
Multi-Line Representative - State Farm Agent Team Member
Jeff Thummel - State Farm Agent —Palm Bay, FL
- $55,000 - $75,000 a year
- Full-time
- Office
- Children
- Organizational skills
- Health insurance
- 401(k)
Quick Apply
College Admissions Representative (On-site in Melbourne)
Arizona College of Nursing —Melbourne, FL
- Full-time
- Writing skills
- High school diploma or GED
- University
- Paid holidays
- Health insurance
Account Representative - State Farm Agent Team Member
Jeff Thummel - State Farm Agent —Palm Bay, FL
- $55,000 - $75,000 a year
- Full-time
- Office
- Children
- Communication skills
- Health insurance
- 401(k)
Quick Apply

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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

member services representative jobs in palm bay fl

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

Member Service Representative (Melbourne Branch)

Member Services Representative

Member Service Representative (Viera West Branch)

Member Service Representative (Rockledge Branch)

FT or PT Medication Technician - 1st or 2nd Shifts

Customer Service Representative - State Farm Agent Team Member

Patient Services Specialist II (Primary Care, Sebastian)

Customer Service Representative - State Farm Agent Team Member

Customer Relations Representative - State Farm Agent Team Member

Crew Member

Patient Service Representative - Dermatology + Plastic Surgery

Customer Service Representative 1st shift + weekends

Melbourne - Teller

Team Member

Account Representative - State Farm Agent Team Member

JUVENILE PROBATION OFFICER - 80061674

Multi-Line Representative - State Farm Agent Team Member

College Admissions Representative (On-site in Melbourne)

Account Representative - State Farm Agent Team Member

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