- Trinity Health (Fort Lauderdale, FL)
- …Care Plans to ensure authorization for hospital stay. Hybrid Position **_Position Purpose:_** ** Utilization Review (UR) Nurses play a vital role in healthcare by ... hospital clinical experience is required.** Recent experience in case management, utilization review , discharge planning, ongoing monitoring and evaluation of… more
- Community Health Systems (Naples, FL)
- **Job Summary** Under the direction of the UR Director/ Manager the UR Nurse reviews all admissions for medical necessity, correct orders based on medical condition ... improvement programs + Addresses facility and departmental communication through daily review of all correspondence, including incoming email messages. + Performs… more
- CenterWell (Tallahassee, FL)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work… more
- CenterWell (Tallahassee, FL)
- …actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that ... Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to… more
- BAYADA Home Health Care (Orlando, FL)
- …full time OASIS Review and Coding Manager . The OASIS and Coding Review Manager provides support to all BAYADA Home Health Care Medicare service offices ... + Candidates should be available Monday-Friday from 8:30am-5:00pm. _Medicare, Coder, OASIS Review , Utilization Review , Quality Assurance, Remote, Home Health… more
- Actalent (Sunrise, FL)
- …+ Prepare and present reports on department activities as assigned. Essential Skills + Clinical review + Utilization review + Utilization management + ... Working under the general supervision of the Director and/or Manager /Supervisor of Medical Management, and in collaboration with an...or LPN License. + Minimum of one year of utilization review experience and discharge planning in… more
- ChenMed (North Miami Beach, FL)
- …assess and record patients' progress and adjust and plan accordingly. + Understanding utilization review and how to leverage with inpatient staff for possible ... as well as, their home environments. The Nurse Case Manager 1 (RN) role also involves establishing relationships with...experience required. + A minimum of 1 year of utilization review and/or case management, home health,… more
- AdventHealth (Orlando, FL)
- …Orlando, FL, 32804 **The role you'll contribute:** The Population Health Case Manager (PHCM) ensures effective utilization and case management oversight ... **Population Health Case Manager (RN) AdventHealth Home Health** **All the benefits...best practices, agency policies/processes. Ensures clear and appropriate visit utilization using evidence-based and best practice guidelines to achieve… more
- GetWellNetwork, Inc. (Tampa, FL)
- …the Tampa, FL Veterans Administration Medical Facility. Get Well's Client Success Manager is responsible for effective product utilization and successful ... Title: Client Service Manager , Government -Tampa, FL Reporting to: Senior Client...next level by driving nurse engagement, focusing on increased utilization , and leading projects of functionality to drive outcomes.… more
- Molina Healthcare (St. Petersburg, FL)
- …SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years ... DESCRIPTION** **Job Summary** Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate level… more