Top 18 Utilization review nurse Jobs in West Palm Beach Fl

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
Staff Nurse, RN
ViaMar Health —West Palm Beach, FL
- $32 - $35 an hour
- Part-time
- Nursing
- Psychiatry
- Inpatient
Quick Apply
1d
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
Case Manager - Acute Rehab Unit
Select Medical Rehabilitation - Palm Beach —Lake Worth, FL
- $45 an hour
- 8 hour shift
- Hospital
- Mid-level
- Rehabilitation center
- Dental insurance
- Paid time off
Quick Apply
Registered Nurse
Henderson Behavioral Health —West Palm Beach, FL
- Full-time
- Background check
- Psychiatry
- Addiction Medicine
- Profit sharing
- Wellness program
Quick Apply
REGISTERED NURSE
THE TREATMENT CENTER —Lake Worth, FL
- Full-time
- CPR Certification
- Nursing
- Heavy lifting
Quick Apply
RN Case Manager - Per Diem
Jupiter Medical Center —Jupiter, FL
- Part-time
- Nursing
- RN License
- Hospital
LICENSED PRACTICAL NURSE
THE TREATMENT CENTER —Lake Worth, FL
- Per diem
- CPR Certification
- Nursing
- Heavy lifting
Quick Apply
Registered Nurse (RN) | Work from home | $34/hr | Starts 8/24/26
Carenet Health —United States
- $34 an hour
- Weekends as needed
- Remote
- Bilingual
- Nursing
- RN License
- Continuing education credits
- Paid holidays
10d

More jobs to discover

Find similar jobs that you might be interested in.

Pool Utilization Review Registered Nurse, Case Management, Per Diem,Shift Varies (Rotating Weekends)
Baptist Health South Florida —Boca Raton, FL
Knowledgeable in local, state, and federal legislation and regulations, and ability to tolerate high volume production standards.
$47 an hour

Explore jobs in cities nearby

Check out jobs in cities near your current location, Columbus

Clinical Review Nurse Supervisor (Medicaid Health Systems Administrator 1)
State of Ohio - Medicaid —Columbus, OH
Or, in order to operate a state vehicle, you must have a valid driver's license from state of residence. Exp. in the delivery of a health services program or…
$40.40 an hour
10d
Utilization Review Specialist - Autism
Nationwide Children's Hospital —Columbus, OH
Bachelor’s Degree in Social Work, Psychology, or related field, required. Documents all case reviews and maintains accurate records of all clinical activities…
10d

Show more jobs in cities nearby

I want to receive the latest job alert for utilization review nurse in west palm beach 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 west palm beach fl

Case Manager jobs in Lake Worth, FL

Registered Nurse jobs in West Palm Beach, FL

Utilization Review Nurse jobs in Boca Raton, FL

Clinician jobs in Florida

Registered Nurse jobs in Honolulu, HI

Operating Room Nurse jobs in Cincinnati, OH

Registered Nurse jobs in Johnstown, PA

Vaccination Nurse jobs in Minnesota

Registered Nurse jobs in Auburn, NY

Registered Nurse jobs in Valley Stream, NY

Pediatric Nurse jobs in Charleston, SC

Registered Nurse Case Manager jobs in Wilmington, DE

Registered Nurse Case Manager jobs in Joplin, MO

Registered Nurse jobs in Happy Valley, OR

Case Manager Remote jobs in Minneapolis, MN

Nurse Informatics jobs in Chicago, IL

Registered Nurse Case Manager jobs in Decatur, IL

Registered Nurse Case Manager jobs in Fredericksburg, TX

Case Manager jobs in Denton, TX

Case Manager jobs in Minnesota

Care Review Clinician (BH Licensed) - Remote in FL

Molina Healthcare, Inc. -
Florida

Apply Now

Job Details

Full-time
$26.41 - $51.49 an hour

Benefits

Health insurance

Qualifications

Productivity software

Full Job Description

JOB DESCRIPTION Job Summary

Provides support for member clinical service review processes specific to behavioral health. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations, and 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 - ensuring 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 and presents cases 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 Molina care model.
Adheres to utilization management (UM) policies and procedures.
May work collaboratively with appropriate departments to provide applied behavior analysis (ABA)/behavioral health therapy (BHT) services to Molina members with autism spectrum disorder (ASD) and other related disorders.
May approve requests for BHT by reviewing behavioral assessments and treatment plans for medical necessity and BHT best practice guidelines. This includes but is not limited to: psychological evaluation requests, comprehensive diagnostic evaluations, functional behavioral assessments, and progress reports.
May perform ongoing monitoring of BHT treatment plans to evaluate effectiveness and treatment efficacy.
May provide peer to peer consultation BHT in-network providers to support treatment planning and maximize member progress.
May work collaboratively with ABA providers to ensure best service practices for members.
May create and develops forms, recommendations and guidelines and training for BHT service delivery.
May collaborate and coordinate with behavioral health medical directors, and senior medical directors to ensure proper management of the BHT benefit.

Required Qualifications

At least 2 years health care experience, including experience in behavioral health and/or hospital acute care, or equivalent combination of relevant education and experience.
Licensed Clinical Social Worker (LCSW), Licensed Master Social Worker (LMSW), Licensed Professional Counselor (LPC), Licensed Professional Clinical Counselor (LPCC), Licensed Marriage and Family Therapist (LMFT) or equivalent behavioral health licensure. License must be active and unrestricted in state of practice.
May require behavioral analyst experience, and/or board certification/licensure as a behavioral analyst (BCBA and/or LBA).
Demonstrated knowledge of community resources.
Ability to operate proactively and demonstrate detail-oriented work.
Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations.
Ability to work independently, with minimal supervision and demonstrate self-motivation.
Responsive in all forms of communication, and ability to remain calm in high-pressure situations.
Ability to develop and maintain professional relationships.
Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change.
Excellent problem-solving, and critical-thinking skills.
Strong verbal and written communication skills.
Microsoft Office suite/applicable software program(s) proficiency.

Preferred Qualifications

Recent hospital behavioral health experience in an intensive care unit (ICU) or emergency room.

#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 west palm beach fl

Care Review Clinician (BH Licensed) - Remote in FL

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

Staff Nurse, RN

Pool Utilization Review Registered Nurse, Case Management

Case Manager - Acute Rehab Unit

Registered Nurse

REGISTERED NURSE

RN Case Manager - Per Diem

LICENSED PRACTICAL NURSE

Registered Nurse (RN) | Work from home | $34/hr | Starts 8/24/26

More jobs to discover

Explore jobs in cities nearby

I want to receive the latest job alert for utilization review nurse in west palm beach fl

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected