Top 43 Utilization review nurse Jobs in Plantation, Fl

Utilization Management Nurse
Solis Health Plans —Miami, FL
- $60,000 - $70,000 a year
- Full-time
- Spanish
- Nursing
- RN License
- Health savings account
- Disability insurance
Quick Apply
1d
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
Quick Apply
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
7d
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
Quick Apply
Clinical Documentation Integrity - Second Level Reviewer
University of Miami —Hialeah, FL
- Full-time
- Remote
- Nursing
- Medicine
- Microsoft Excel
- Health insurance
- Dental insurance
Case Manager (LPN - Bilingual Spanish)
Sky Nurses —Boca Raton, FL
- $25 - $35 an hour
- Weekends as needed
- Spanish
- Nursing
- HIPAA
- Paid holidays
- Health insurance
Quick Apply
UM Clinical Reviewer
Centers Plan for Healthy Living —Margate, FL
- Full-time
- RN License
- Communication skills
- Entry level
Quick Apply
Concurrent Review Nurse
Leon Health —Miami, FL
- Spanish
- Nursing
- English
8d
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
RN Case Manager
Cleveland Clinic —Weston, FL
- Full-time
- Acute care
- Nursing
- RN License
6d
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 - Pool Days - BHMC
Broward Health —Fort Lauderdale, FL
- Day shift
- Acute care
- Nursing
- RN License
Case Manager, Acute Care - Case Mgmt - PT Days - BHN
Broward Health —Deerfield Beach, FL
- Part-time
- Acute care
- Nursing
- RN License
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
14d
Case Manager, Acute Care - Case Mgmt - Pool Days - BHCS
Broward Health —Coral Springs, FL
- Day shift
- Acute care
- Nursing
- RN License
6d
Case Management RN
Sanitas Medical Center —Doral, FL
- Full-time
- Spanish
- Master of Social Work
- Nursing
Quick Apply

I want to receive the latest job alert for utilization review nurse in plantation, fl

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

utilization review nurse jobs near plantation, fl

Utilization Management Nurse

Solis Health Plans -
Miami, FL

Quick Apply

Job Details

Full-time
$60,000 - $70,000 a year
1 day ago

Benefits

Health savings account
Disability insurance
Health insurance
Dental insurance
401(k)
Paid time off
Vision insurance
401(k) matching

Qualifications

Spanish
Nursing
RN License
English
Bachelor's degree

Full Job Description

About us:

Solis Health Plans is a new kind of Medicare Advantage Company. We provide solutions that are more transparent, connected and effective for both our members and providers. Solis was born out of a desire to provide a more personal experience throughout all levels of the healthcare journey. Our team consists of expert individuals that take pride in delivering quality service. We believe in a culture that collaborates and supports one another, and where success is interlinked and each employee is valued. Please check out our company website at www.solishealthplans.com to learn more about us!

**Bilingual in English and Spanish is required**

Full benefits package offered on the first on the month following date of hire including: Medical, Dental, Vision, 401K plan with a 100% company match!

Our company has doubled size and we have experienced exponential growth in membership from 2,000 members to over 20,000 members!

Join our winning Solis Team!

Position is fully onsite Monday-Friday.

Location: 9250 NW 36th St, Miami, FL 33178.

Position Summary:

Under the supervision of the Health Services Director, the Utilization Management Nurse (LPN or RN) uses a multidisciplinary approach to organize, coordinate, monitor, evaluate, create and manage organization determinations and authorizations. These service requests will focus on selected complex medical and psychosocial needs of Solis Health Plans members. The UM Nurse is responsible for assuring the receipt of high quality, cost efficient medical outcomes for enrollees. This role works with Medical Directors, Authorization Coordinators and Service Coordinators to perform first level review to pre-certify elective services, procedures and tests utilizing established Care Coordination polices and protocols, Solis Health Plans benefit criteria, applicable regulatory review criteria and nationally accepted criteria for medical necessity determination.

Main Key Responsibilities:

Conduct concurrent and retrospective utilization review for inpatient, observation or SNF services.
Conducts clinical reviews of proposed services against appropriate criteria/guidelines to determine medical necessity, benefit eligibility, and network contract status.
Work with Medical Directors, Program Leadership and Solis Health Plans Provider Relations Teams to identify and mitigate facility barriers associated with the ability to make timely decisions.
Identify, align and utilize health plan and community resources that impact high-risk/high cost care.
Act as liaison between assigned facilities, members/families, and Solis Health Plans. Clarify policies/procedures and member benefits as needed. Authorizes services, coordinates care, and ensures timeliness and coordination of healthcare services, in compliance with department and regulatory standards, seeking supplemental services when appropriate or when needed.
Assess enrollee needs and monitor progress toward goals at all times, communicating findings and status with members of the enrollee’s primary care team.
Ensure optimal delivery of safe quality health care to members, while maximizing resources and containing costs, and facilitate continual patient-centered and outcome-driven health performance improvement activities.
Review enrollees with the Medical Directors and Primary Care Teams and advocates for Administration Exception considerations as appropriate.
Facilitate communications between the facility, providers, and the PCT in order to effect and influence a safe and effective discharge plan and care plan for the enrollee.

Qualifications:

Graduate from an accredited school of nursing, or Bachelors (or advanced) degree in nursing.
Active and unrestricted licensure as a Registered Nurse in Florida.
A minimum of three to five years clinical experience as a Registered Nurse in a clinical setting required.
2 years’ experience as a Utilization Management nurse in a managed care payer preferred.
One year experience as a case manager in a payer or facility setting highly preferred.
Discharge planning experience highly preferred.

What Sets Us Apart:

Join Solis Health Plans as a Utilization Management Nurse and become a catalyst for positive change in the lives of our members. At Solis, you will be part of a locally rooted organization deeply committed to understanding and serving our communities. If you are eager to embark on a purpose-driven career that promises growth and the chance to make a significant impact, we encourage you to explore the opportunities available at Solis Health Plans. Join us and be the difference!

Job Type: Full-time

Pay: $60,000.00 - $70,000.00 per year

Benefits:

401(k)
401(k) matching
Dental insurance
Disability insurance
Health insurance
Health savings account
Paid time off
Vision insurance

Ability to Commute:

Miami, FL 33178 (Required)

Ability to Relocate:

Miami, FL 33178: Relocate before starting work (Required)

Work Location: In person

Quick Apply

Refine Your Search

utilization review nurse jobs in plantation, fl

Utilization Management Nurse

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

Case Manager (LPN - Bilingual Spanish)

UM Clinical Reviewer

Concurrent Review Nurse

Care Review Clinician (BH Licensed) - Remote in FL

RN Case Manager

CLINICAL CARE MANAGER / RN

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

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

Home Health Wound Care RN

Manager, Case Management

Team Manager Home Care

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

Case Management RN

I want to receive the latest job alert for utilization review nurse in plantation, fl

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected