• Utilization Review Nurse

    Actalent (Sunrise, FL)
    Job Title: Utilization Review NurseJob Description The Utilization Management Nurse (UMN) collaborates closely with the interdisciplinary team to perform ... UMN assists in complex cases, develops internal processes, and educates physicians on utilization review issues. The role involves managing continuity of care,… more
    Actalent (07/04/25)
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  • Utilization Review Nurse

    Actalent (Sunrise, FL)
    Utilization Management Nurse !Job Description The ...on department activities as assigned. Essential Skills + Clinical review + Utilization review + ... unrestricted Florida RN or LPN License. + Minimum of one year of utilization review experience and discharge planning in an acute care setting. + Four years… more
    Actalent (07/04/25)
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  • Medical Claim Review Nurse (RN)

    Molina Healthcare (Miami, FL)
    …SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two years ... set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. **Job Summary** Utilizing clinical knowledge and experience,… more
    Molina Healthcare (07/03/25)
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  • Acute Care Case Manager , Registered Nurse

    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 ... great people to join our team. The Acute Care Nurse (RN) is responsible for achieving positive patient outcomes...experience required. + A minimum of 1 year of utilization review and/or case management, home health,… more
    ChenMed (05/28/25)
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  • Med Mgmt Nurse (US)

    Elevance Health (Miami, FL)
    …or case management experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or any combination of education ... - 6pm EST and will include weekends. The **Medical Management Nurse ** will be responsible for review of the most complex or challenging cases that require… more
    Elevance Health (07/03/25)
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  • Registered Nurse RN Case Mgr IRF

    HCA Healthcare (Miami, FL)
    …2 years of critical care experience + Certification in case management or utilization review preferred + InterQual experience preferred HCA Florida Mercy ... opportunity to make a real impact. As a(an) Registered Nurse RN IRF you can be a part of...location._** It is an exciting time to be a nurse at HCA Healthcare! Come unlock your career potential… more
    HCA Healthcare (06/27/25)
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  • Registered Nurse RN Case Manager PRN

    HCA Healthcare (Miami, FL)
    …or 2 years of critical care experience + Certification in case management or utilization review preferred + InterQual experience preferred + This position may be ... Do you have the career opportunities as a(an) Registered Nurse RN Case Manager PRN you want with your...Nurse RN Case Manager PRN opening. We promptly review all applications. Highly qualified candidates will be contacted… more
    HCA Healthcare (06/21/25)
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  • Nurse Simulation Instructor - Per Diem

    University of Miami (Miami, FL)
    …staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The Gordon ... Center is seeking several qualified Nurse Simulation Instructors 1, 2 and 3- Per Diem....that test learner knowledge and skills through simulation and utilization of standardized patients (actors). + Manages off-site courses… more
    University of Miami (05/07/25)
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  • Dialysis Clinical Manager Registered Nurse

    Fresenius Medical Center (Hollywood, FL)
    …all FMS manuals. + Accountable for completion of the Annual Standing Order Review and ICD coding. + Checks correspondence whether electronic, paper or voice mail, ... supporting billing and collection activities. + Responsible for efficient utilization of medication, laboratory, inventory, supplies and equipment to achieve… more
    Fresenius Medical Center (06/14/25)
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  • RN Care Review Clinician, Inpatient…

    Molina Healthcare (Miami, FL)
    **JOB DESCRIPTION** For this position we are seeking a (RN) Registered Nurse who lives in South Carolina, Virginia, Tennessee, North Carolina, or Florida and must be ... Behavioral health services. Strongly prefer candidates with a background on utilization management or appeals. Excellent computer multi-tasking skills and good… more
    Molina Healthcare (06/22/25)
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  • Medical Director (Marketplace)

    Molina Healthcare (Miami, FL)
    …the Chief Medical Officer. + Evaluates authorization requests in timely support of nurse reviewers; reviews cases requiring concurrent review , and manages the ... and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource… more
    Molina Healthcare (06/29/25)
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  • Supervisor, Intensive Community Care RN

    ChenMed (North Miami Beach, FL)
    …in state. + A minimum of 2 years' onsite case management at ChenMed and/or utilization review or discharge planning in a hospital at ChenMed. Special permission ... patients achieve optimal health, access to care and appropriate utilization of resources. + Consults with, encourages and influences...in related field preferred. + Must be a Registered Nurse with over three (3) years of clinical experience.… more
    ChenMed (07/02/25)
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  • APP, Supervisor - General Internal Medicine - Full…

    University of Miami (Miami, FL)
    …staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . APP, ... supervises advance d practice providers (APPs) ( ie, Advanced Registered Nurse Practitioners, Physician Assistants etc.). Key responsibilities of this position… more
    University of Miami (06/16/25)
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  • Case Manager, RN

    University of Miami (Medley, FL)
    …staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The UHealth ... + Evaluates the plan of care regularly by chart review and patient interviews, as well as collaborates with...Degree/ Bachelor's Degree in Nursing Certification and Licensing: Registered Nurse (RN) CCM a plus Experience: Minimum 2 years… more
    University of Miami (06/24/25)
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  • Core Desk Coordinator - SoLe Mia

    University of Miami (North Miami, FL)
    …staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The ... FUNCTIONS Creates and assesses the daily schedule to plan optimal staff utilization and functioning of the operative schedule. Maintains effective lines of… more
    University of Miami (05/19/25)
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  • APP Supervisor - Surgery, Colorectal - Jackson…

    University of Miami (Doral, FL)
    …staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . APP ... supervises advance d practice providers (APPs) ( ie, Advanced Registered Nurse Practitioners, Physician Assistants etc.). Key responsibilities of this position… more
    University of Miami (04/11/25)
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  • Critical Care Technician, Emergency, Full-time

    University of Miami (Miami, FL)
    …work in our Emergency department. The Critical Care Technician conducts drug utilization review studies, and consults with medical practitioners on prescription ... faculty or staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The University of… more
    University of Miami (06/27/25)
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  • Director of Quality Management - Inpatient Rehab

    Select Medical (Miami, FL)
    …documentation related to the hospital's CQI program. + Performs basic chart review activities with appropriate staff for outcome utilization , infection control ... and medical CQI indicators. Analyzes results of chart review activities with appropriate staff and confers with department staff on any case requiring special… more
    Select Medical (06/20/25)
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  • Case Manager RN PRN

    HCA Healthcare (Tamarac, FL)
    …or 2 years of critical care experience + Certification in case management or utilization review preferred + InterQual experience preferred Founded in 1974, HCA ... for benefits may vary by location._** It is an exciting time to be a nurse at HCA Healthcare! Come unlock your career potential and see how rewarding it can… more
    HCA Healthcare (07/01/25)
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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 ... expense management. Manages financial resources for the department to achieve optimal utilization and outcomes. + Promotes high standards and holds staff and… more
    Trinity Health (07/01/25)
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