• Utilization Management Nurse

    Actalent (Sunrise, FL)
    Actalent is hiring a Utilization Management Nurse ! Job Description The Utilization Management Nurse (UMN) collaborates closely with the ... activities as assigned. Essential Skills + Clinical review + Utilization review + Utilization management + InterQual + Milliman Commercial Guidelines… more
    Actalent (07/04/25)
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  • Utilization Review Nurse

    Actalent (Sunrise, FL)
    Utilization Management Nurse !Job Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing service authorization ... activities as assigned. Essential Skills + Clinical review + Utilization review + Utilization management + Interqual + Milliman Commercial Guidelines… more
    Actalent (07/04/25)
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  • Acute Care Case Manager , Registered Nurse

    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
    ChenMed (05/28/25)
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  • Med Mgmt Nurse (US)

    Elevance Health (Miami, FL)
    **Medical Management Nurse ** **Location:** Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training ... - 6pm EST and will include weekends. The **Medical Management Nurse ** will be responsible for review...experience and requires a minimum of 2 years clinical, utilization review, or managed care experience; or any combination… more
    Elevance Health (07/03/25)
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  • RN Nurse Manager Critical Care

    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
    HCA Healthcare (06/21/25)
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  • Registered Nurse RN Case Mgr IRF

    HCA Healthcare (Miami, FL)
    …Experience or 2 years of critical care experience + Certification in case management or utilization review preferred + InterQual experience preferred HCA Florida ... opportunity to make a real impact. As a(an) Registered Nurse RN IRF you can be a part of...collaborates with the Rehab Program Director and Facility Case Management Director regarding departmental functions. The CM coordinates efforts… more
    HCA Healthcare (06/27/25)
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  • Registered Nurse RN Case Manager PRN

    HCA Healthcare (Miami, FL)
    …+ Experience or 2 years of critical care experience + Certification in case management or utilization review preferred + InterQual experience preferred + This ... Do you have the career opportunities as a(an) Registered Nurse RN Case Manager PRN you want with your...collaborates with the Rehab Program Director and Facility Case Management Director regarding departmental functions. The CM coordinates efforts… more
    HCA Healthcare (06/21/25)
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  • Registered Nurse , Telehealth - Remote- ER…

    ChenMed (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 (06/18/25)
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  • Registered Nurse Surgery Center

    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
    Fresenius Medical Center (06/14/25)
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  • Medical Claim Review Nurse (RN)

    Molina Healthcare (Miami, FL)
    …of payment decisions. + Serves as a clinical resource for Utilization Management , Chief Medical Officers, Physicians, and Member/Provider Inquiries/Appeals. ... ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review. + Minimum two years of experience in… more
    Molina Healthcare (07/03/25)
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  • Dialysis Clinical Manager Registered Nurse

    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
    Fresenius Medical Center (06/14/25)
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  • Medical Director (Marketplace)

    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 (06/29/25)
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  • Director of Quality Management - Inpatient…

    Select Medical (Miami, FL)
    …Miami, FL** **$10,000 Sign-on Bonus** **Director of Quality Management ** **(DQM)** **Responsibilities** **Position Summary** Coordinates the Medical Quality ... Management and Performance Improvement activities to measurably enhance the...basic chart review activities with appropriate staff for outcome utilization , infection control and medical CQI indicators. Analyzes results… more
    Select Medical (06/20/25)
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  • Case Manager / PRN ( RN / RT / SW / LPN )

    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
    Select Medical (06/21/25)
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  • Home Health Wound Care RN

    Humana (Miramar, FL)
    …providers to ensure cohesive and evidence-based care. - Oversee and optimize utilization management processes within the organization. - Ensure resource ... practices in wound care but also aim at controlling utilization to improve patient outcomes. The expertise of a...Educate home health clinicians and physicians on proper wound management techniques. - Focus on care for patients with… more
    Humana (06/10/25)
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  • Supervisor, Intensive Community Care RN

    ChenMed (North Miami Beach, FL)
    …license required if available in state. + A minimum of 2 years' onsite case management at ChenMed and/or utilization review or discharge planning in a hospital ... multiple regions, to serve as coach, mentor/trainer to all members of care management team, giving guidance in best practices, troubleshooting to optimize the value… more
    ChenMed (07/02/25)
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  • UM Clinical Reviewer

    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
    Centers Plan for Healthy Living (04/15/25)
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  • RN Care Review Clinician, Inpatient Review

    Molina Healthcare (Miami, FL)
    …and Behavioral health services. Strongly prefer candidates with a background on utilization management or appeals. Excellent computer multi-tasking skills and ... Medical, or ER unit. **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). To all current Molina… more
    Molina Healthcare (06/22/25)
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  • Director - Neuroscience Service Line

    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
    Trinity Health (07/01/25)
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  • Case Manager, RN

    University of Miami (Medley, FL)
    …Education: Bachelor's Degree/ Bachelor's Degree in Nursing Certification and Licensing: Registered Nurse (RN) CCM a plus Experience: Minimum 2 years of relevant ... potentially complex clients who would benefit from a patient-centered care management program to ensure medically appropriate, high quality, cost effective care.Care… more
    University of Miami (06/24/25)
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