- Actalent (Sunrise, FL)
- Actalent is hiring UM nurses!Job Description The Utilization Management Nurse (UMN) plays a crucial role in optimizing the utilization of healthcare ... on department activities. Essential Skills + Clinical review + Utilization review + Utilization management + Interqual + Milliman Commercial Guidelines… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …safe discharge coverage for all hospital units. + Participates in utilization management initiatives/opportunities for improvement through departmental committee ... Onsite Position Position Purpose: Works in partnership with physicians, nurse case managers, and other disciplines to ensure the...Florida. + 3 years minimum experience in discharge planning, utilization management , or case management .… 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
- Veterans Affairs, Veterans Health Administration (Miami, FL)
- …in the CLC. Documents and takes corrective action when notified by the CLC management team, charge nurse , or designee of any discrepancies in coding or ... Miami VA Healthcare System is looking for a Registered Nurse - Community Living Center - Minimum Data Set...for the coordination of care focused on patient education, self- management , and customer satisfaction throughout the continuum 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
- MyFlorida (Pembroke Pines, FL)
- REGISTERED NURSE - 50556016 Date: Jun 3, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify Website ... . Requisition No: 854302 Agency: Veterans Affairs Working Title: REGISTERED NURSE - 50556016 Pay Plan: Career Service Position Number: 50556016 Salary:… 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
- HCA Healthcare (Margate, FL)
- …setting + Minimum 1 year of experience as a full time Charge Nurse / Coordinator, Nursing Administrative Supervisor, or Nursing Management HCA Florida Northwest ... care in 21 states and the United Kingdom. We are looking for a RN Nurse Manager Critical Care for our HCA Florida Northwest Hospital team where excellence creates… more
- ChenMed (North Miami Beach, 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 (Miami, FL)
- …expanding and we need great people to join our team. The Registered Nurse , Care Line, is responsible for providing telephonic triage directional patient care advice ... client counseling, patient advocacy, health education and referral and resource management to ChenMed patients and their families. Providing on-call coverage, the… more
- ChenMed (Tamarac, 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
- Fresenius Medical Center (Miami, FL)
- …direction of the Facility Manager, Director of Nursing and/or Charge Registered Nurse , utilizing standard nursing techniques to assist the physician in optimum ... on adverse events and action thresholds in collaboration with facility management . + Maintains integrity of medical records and other organization administrative… more
- CVS Health (Hialeah, FL)
- …The Care Manager RN is responsible for driving and supporting care management and care coordination activities across the continuum of care (assessing, planning, ... and coordination of psychosocial wrap around services to promote effective utilization of available resources and optimal, cost-effective outcomes. The schedule for… more
- Fresenius Medical Center (Hollywood, FL)
- …and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely ... workup of patients for access management , dialysis services, patient education, hospitalizations, and kidney transplantation as appropriate, and ensures coordination… 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
- Centers Plan for Healthy Living (Margate, FL)
- …Plan For Healthy Living is currently accepting applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer ... or support in their home to improve their quality of life. Utilization Management Clinical Reviewer will assess and process all authorization requests to… 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