Top 43 Utilization review nurse Jobs in Pompano Beach Fl

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
Care Review Clinician (BH Licensed) - Remote in FL
Molina Healthcare, Inc. —Florida
- $26.41 - $51.49 an hour
- Full-time
- Remote
- LMFT
- Licensed Clinical Social Worker
- Mid-level
- Health insurance
Pool Utilization Review Registered Nurse, Case Management, Per Diem,Shift Varies (Rotating Weekends)
Baptist Health South Florida —Boca Raton, FL
- $47 an hour
- Rotating weekends
- Nursing
- RN License
- Mid-level
- Wellness program
- 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
Medical Review Nurse - CMS RAC (Government audits)
Performant Financial Corporation —Plantation, FL
- $81,000 - $90,000 a year
- Full-time
- Remote
- RN License
- Computer literacy
- Writing skills
- Health savings account
- Paid holidays
Pool Utilization Review Registered Nurse, Case Management
Boca Raton Regional Hospital —Boca Raton, FL
- $47 an hour
- Nursing
- RN License
- Mid-level
- Wellness program
- Health insurance
UM Clinical Reviewer
Centers Plan for Healthy Living —Margate, FL
- Full-time
- RN License
- Communication skills
- Entry level
Quick Apply
Clinical Reviewer Nurse
Integrated Home Care Acquisition —Miramar, FL
- RN License
- Word processing
- Mid-level
- Paid training
- Wellness program
Quick Apply
Case Manager, Acute Care - Case Mgmt - FT - Days - BHMC
Broward Health —Fort Lauderdale, FL
- Full-time
- Acute care
- Nursing
- RN License
Case Manager, Acute Care - Case Mgmt - FT Days - BHN
Broward Health —Deerfield Beach, FL
- Full-time
- Acute care
- Nursing
- RN License
12d
Medical Review Clinical Appeals Auditor (RN)
Performant Financial Corporation —Plantation, FL
- $80,000 - $90,000 a year
- Full-time
- Microsoft Excel
- RN License
- Computer literacy
- Health savings account
- Paid holidays
Case Manager, Acute Care - Case Mgmt - FT Days - BHIP
Broward Health —Fort Lauderdale, FL
- Full-time
- Acute care
- Nursing
- RN License
4d
Case Manager, Acute Care - Case Mgmt - FT - Days - BHN
Broward Health —Deerfield Beach, FL
- Full-time
- Acute care
- Nursing
- RN License
Case Manager, Acute Care - Case Mgmt - Pool Days - BHMC
Broward Health —Fort Lauderdale, FL
- Acute care
- Nursing
- RN License
Clinical Reviewer Nurse, CWOCN
Integrated Home Care Acquisition —Miramar, FL
- Nursing
- RN License
- Word processing
- Paid training
- Wellness program
Quick Apply
Case Manager, Acute Care-Case Mgmt-Pool-Days-BHMC #27788
Broward Health —Fort Lauderdale, FL
- Acute care
- Nursing
- RN License
Case Manager, Acute Care - Case Mgmt - Pool - Days - BHMC
Broward Health —Fort Lauderdale, FL
- Acute care
- Nursing
- RN License
MDS Coordinator (RN)
The Legacy at Boca Raton Rehabilitation and Nursing Center —Boca Raton, FL
- Full-time
- Skilled nursing facility
- RN License
- Mid-level
- Paid holidays
- Health insurance
Quick Apply
Registered Nurse Supervisor - Evening
Regents Park of Sunrise —Sunrise, FL
- Overnight shift
- Patient monitoring
- RN License
- BLS Certification
- Paid training
- Disability insurance
Quick Apply
6d
Home Health-Intake RN/LPN
Southeastern Health Management —Plantation, FL
- Full-time
- Bilingual
- Nursing
- RN License
Quick Apply

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utilization review nurse jobs near pompano beach fl

Care Review Clinician (RN) - Remote in FL

Molina Healthcare, Inc. -
Florida

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

utilization review nurse jobs in pompano beach fl

Care Review Clinician (RN) - Remote in FL

Care Review Clinician (BH Licensed) - Remote in FL

Pool Utilization Review Registered Nurse, Case Management, Per Diem,Shift Varies (Rotating Weekends)

Utilization Review Specialist

Medical Review Nurse - CMS RAC (Government audits)

Pool Utilization Review Registered Nurse, Case Management

UM Clinical Reviewer

Clinical Reviewer Nurse

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

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

Medical Review Clinical Appeals Auditor (RN)

Case Manager, Acute Care - Case Mgmt - FT Days - BHIP

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

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

Clinical Reviewer Nurse, CWOCN

Case Manager, Acute Care-Case Mgmt-Pool-Days-BHMC #27788

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

MDS Coordinator (RN)

Registered Nurse Supervisor - Evening

Home Health-Intake RN/LPN

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