Top 16 Utilization management nurse Jobs in Sebring, 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
14d
Registered Nurse Care Management
AdventHealth Sebring —Sebring, FL
- $32.16 - $56.28 an hour
- Full-time
- Background check
- Nursing
- Microsoft Outlook
- Paid parental leave
- Disability insurance
11d
Nurse Program Case Manager
Adult Community Educational Services, Inc (ACES) —Wauchula, FL
- $60,000 - $80,000 a year
- Full-time
- Background check
- Nursing
- Medication administration
- Health insurance
- Dental insurance
Quick Apply
SENIOR COMMUNITY HEALTH NURSE - 64086278
The State of Florida —Sebring, FL
- $66,652.61 a year
- Full-time
- Background check
- CPR Certification
- Nursing
- Paid holidays
- Dental insurance
11d
Cardiology Nurse Practitioner
AdventHealth Sebring —Sebring, FL
- Up to $2,080,000 a year
- Full-time
- Background check
- CPR Certification
- Nursing
- Paid parental leave
- Disability insurance
10d
RN Registered Nurse Home Health
AdventHealth Home Health and Hospice —Sebring, FL
- $31.53 - $50.40 an hour
- Full-time
- Background check
- CPR Certification
- Nursing
- Paid parental leave
- Disability insurance
Nurse Practitioner
Banyan Treatment Centers —Sebring, FL
- Part-time
- Nursing
- Addiction Medicine
- Mid-level
- Wellness program
- Paid holidays
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Registered Nurse Med Surg Medical Unit Nights
AdventHealth Wauchula —Wauchula, FL
- $31.53 - $50.40 an hour
- Extended hours
- Background check
- CPR Certification
- Nursing
- Paid parental leave
- Disability insurance
Complex Care Manager RN-Western MA (Hybrid)
WellSense Health Plan —United States
- $74,000 - $107,000 a year
- Full-time
- Hybrid work
- Background check
- School experience
- Nursing
- Health insurance
- Dental insurance

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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
14 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

utilization management nurse jobs in sebring, fl

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

Registered Nurse Care Management

Nurse Program Case Manager

SENIOR COMMUNITY HEALTH NURSE - 64086278

Cardiology Nurse Practitioner

RN Registered Nurse Home Health

Nurse Practitioner

Registered Nurse Med Surg Medical Unit Nights

Complex Care Manager RN-Western MA (Hybrid)

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