- Actalent (Sunrise, FL)
- Job Title: Utilization Management NurseJob Description The Utilization Management Nurse (UMN) plays a crucial role in optimizing the utilization ... on department activities. Essential Skills + Clinical review + Utilization review + Utilization management + Interqual + Milliman Commercial Guidelines… more
- ChenMed (North Miami Beach, FL)
- …years' clinical work experience required. + A minimum of 1 year of utilization review and/or case management , home health, hospital discharge planning experience ... expanding and we need great people to join our team. The Acute Care Nurse (RN) is responsible for achieving positive patient outcomes and managing quality of care… more
- Actalent (Sunrise, FL)
- …a managed care, health plan, or insurance setting. + Experience with Utilization Management and Care Coordination. + Knowledge of Medicaid/Medicare Regulations. ... and complex case management . + Engage with Medical Directors and care management staff to direct appropriate utilization and data capture. + Educate members,… more
- ChenMed (Miami, FL)
- … management programs, clinical meetings and other meetings. The Nurse Practitioner will adhere to strict departmental goals/objectives, standards of performance, ... we need great people to join our team. The Nurse Practitioner (NP) acts as part of the clinical...nursing plan of care, health education, physician referrals, case management referrals, follow-up and clear documentation according to ChenMed… more
- Molina Healthcare (Miami, FL)
- …Chief Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + ... as may be required. + Serves as a clinical resource for Utilization Management , Chief Medical Officer, Physicians, and Member/Provider Inquiries/Appeals. +… more
- Elevance Health (Miami, FL)
- … plan and modifies as necessary. + Assists with the development of utilization /care management policies and procedures. + Participates in or leads ... ** Nurse Care Manager II** **Location:** This role enables...with healthcare providers and/or consumer to drive personalized health management and improve health outcomes for optimal consumers. Performs… more
- ChenMed (North Miami, FL)
- …expanding and we need great people to join our team. The Registered Nurse , Telehealth is responsible for providing telephonic triage directional patient care advice ... issues, client counseling, patient advocacy, health education and referral and resource management to ChenMed patients and their families. The incumbent in this role… more
- ChenMed (North Miami, FL)
- …we need great people to join our team. The Part Time Registered Nurse , Virtual Care, is responsible for providing telephonic emergency triage and directional patient ... client counseling, patient advocacy, health education and referral and resource management to ChenMed patients and their families. Providing on-call coverage, the… more
- University of Miami (Miami, FL)
- …of Case Management . + Incorporates the fundamental principles of utilization management , monitoring resource consumption, social services intervention and ... Miami/UHealth has an exciting opportunity for an RN Case Manager in the Case Management department at the UTower location. This position functions as a RN Case… more
- Molina Healthcare (Miami, FL)
- … and effective resource management . + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure ... IT and data analysts to produce tools to report, monitor and improve Utilization Management . + Actively participates in regulatory, professional and community… more
- Molina Healthcare (Miami, FL)
- … and effective resource management . + Develops and implements a Utilization Management program and action plan, which includes strategies that ensure ... IT and data analysts to produce tools to report, monitor and improve Utilization Management . + Actively participates in regulatory, professional and community… more
- Select Medical (Miami, FL)
- … within the plan of care. + Demonstrates compliance with facility-wide Utilization Management policies and procedures. + Coordinates UR compliance with ... current licensure in a clinical discipline either as a Nurse or a Respiratory Therapist OR Social Work SW/MSW...what is right. The Case Manager is responsible for utilization reviews and resource management , discharge planning,… more
- Elevance Health (Miami, FL)
- **Clinical Operations Medical Director** **Medical Oncology** **Carelon Medical Benefit Management ** **Virtual:** This role enables associates to work virtually ... proud member of the Elevance Health family of companies, Carelon Medical Benefits Management , formerly AIM Specialty Health, is a benefit- management leader in… more
- MyFlorida (Miami, FL)
- …records as part of the inspection of office surgery centers and pain management clinics throughout the state to ensure compliance with state requirements. + Identify ... appropriate provisions of medical records for surgical and pain management patients based on the current administrative rules and statutes. + Document findings and… more
- HCA Healthcare (Miami, FL)
- …Develop processes for monitoring and improving the financial performance and resource utilization of the Trauma Center. + Perform strategic planning and coordinate ... you will need:** + Current Florida license as Registered Nurse or Recognized Compact Licensure (subject to Florida State...trauma intensive care unit + Background in trauma system management essential - required HCA Florida Kendall Hospital is… more
- Molina Healthcare (Miami, FL)
- …requests for transplants; the ideal candidate will have experience either in utilization review or case management for transplants. Preference will be ... **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN in United States who has...**JOB QUALIFICATIONS** **Required Education** Completion of an accredited Registered Nurse (RN). **Required Experience** 1-3 years of hospital or… more
- Trinity Health (Fort Lauderdale, FL)
- …centered delivery of care, with a highly engaged, collaborative Physician, Nurse and support team. They will support local financial performance, quality/safety/risk ... partnerships. The role of the Director is crucial to ensuring the effective management and coordination of health services within Holy Cross. This position demands a… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- POSITION PURPOSE: The Nurse Case Manager who is responsible for coordinating the continuum of care activities for assigned patients and ensuring optimum ... utilization of resources, service delivery and compliance with medical...assigned/necessary. + To promote member safety through a pharmaceutical management program, The CM is expected to complete medication… more
- HCA Healthcare (Aventura, FL)
- …Develop processes for monitoring and improving the financial performance and resource utilization of the Trauma Center. + Perform strategic planning and coordinate ... you will need:** + Current Florida license as Registered Nurse or Recognized Compact Licensure (subject to Florida State...trauma intensive care unit + Background in trauma system management essential - required HCA Florida Aventura Hospital is… more
- ChenMed (Miami, FL)
- …trends in patient conditions and develops, documents and implements a patient management plan based on interpretation of findings. Aids in the development of ... plan of care that may include health education, physician referrals, case management referrals and patient/family counseling. + Evaluates need for immediate nursing… more