2d
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Utilization Specialist
Ocklawaha, Florida, United States
$20-$24/hr OnsiteFull Time
2+ YOEHigh school diploma required; clinical experience or 2+ years working with the population; CPR, de-escalation and restraint certification required; EMR/administrative skills and ability to coordinate utilization reviews and appeals.
1w
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Utilization Review Coordinator
Jacksonville, Florida, United States
OnsiteFull Time
2+ YOEBachelor's in healthcare or related, 2+ years utilization review or clinical experience, knowledge of medical terminology, payer guidelines, insurance authorization processes, strong analytic and communication skills.
Electronic Health Records (EHR), utilization management software
1w
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Utilization Review Coordinator
Port St. Lucie, Florida, United States
OnsiteFull Time
2+ YOECoordinate insurance reviews, monitor authorizations, review records, prepare reports and appeals; RN or LPN or equivalent clinician experience, CPR required, 2+ years preferred, knowledge of utilization review and medical terminology.
1mo
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Utilization Review Nurse
Orlando or United States
$90k-$98k/yr RemoteFull Time
3+ YOEActive unrestricted RN license, minimum 3 years clinical nursing experience, 1+ year UM/UR experience, proficiency with Microsoft Office (Excel, Word, Outlook) and utilization management systems, strong analytical and communication skills.
Milliman, Aetna, BCBS, Microsoft Office Suite, Microsoft Excel, Microsoft Word, Microsoft Outlook, Microsoft Teams
2w
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Director, Utilization Management
Miami, Florida, United States
OnsiteFull Time
5+ YOEBachelor's degree required,5 years utilization management or related healthcare experience,knowledge of healthcare regulations,leadership experience preferred,ACM/CCM certification desirable.
2w
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DIR - UTILIZATION REVIEW / MGMT
Jacksonville, Florida, United States
OnsiteFull Time
Must be an RN or have a Bachelor’s in Social Work/Psychology with utilization review/management experience; knowledge of regulatory and reimbursement requirements; ability to evaluate records and supervise staff.
2w
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Utilization Review Specialist (Remote)
El Paso or Chapel Hill or Delray Beach or Jackson
$60k-$62k/yr RemoteFull Time
3+ YOEBA in Psychology or related field, 3–5 years case management/utilization review experience in substance abuse, knowledge of ASAM and medical terminology, KIPU experience required, strong communication and supervisory ability.
KIPU, Best Notes
1mo
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UTILIZATION REV SPEC I
Orlando, Florida, United States
OnsiteFull Time
2+ YOEHigh school diploma/GED, Level II background clearance, valid driver’s license; 2 years utilization review/managed care experience required; BLS required; LPN/RN and bachelor’s degree preferred.
1d
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Utilization Management Specialist – Acute Care
Naples, Florida, United States
OnsiteFull Time, Part Time
1+ YOEHigh school diploma and 1+ year experience in utilization review, authorizations, case management or related field; EHR and payer portal experience; strong documentation, organizational, and HIPAA knowledge; ability to pass fingerprint, drug screen, and background check.
Electronic Health Records (EHR), Microsoft Office 365, Microsoft Teams, payer portals
3w
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Regional Manager Utilization Management
Cleveland or Indian River County or Martin County or Weston or Florida
RemoteFull Time
3+ YOE1+ MgmtBachelor's degree and RN program completion, Florida RN license, BLS required, 3 years clinical nursing, 2 years utilization review/care management, 1 year healthcare management, proficiency with Microsoft Office and clinical/financial systems, data analysis and UR knowledge.
Microsoft Office
1mo
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Hybrid, Per-diem Utilization Review RN
Fort Lauderdale, Florida, United States
HybridPart Time
Licensed RN in Florida required; graduate of accredited nursing school; BSN preferred; knowledge of utilization management and MCG/InterQual criteria; ability to review admissions, monitor authorizations, and coordinate physician advisor referrals.
MCG, InterQual
1d
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Acquisition & Utilization Specialist
Tampa, Florida, United States
$75k-$97k/yr OnsiteFull Time
1+ YOEOne year specialized experience in healthcare contracting and procurement, familiarity with FAR/VAAR, ability to prepare procurement packages and support contract administration; U.S. citizenship and selective service compliance required.
4d
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Utilization Review Clinician
Miami or United States
RemoteFull Time
1+ YOEMaster's in a mental health-related field, 1+ year experience with insurance authorizations/managed care, licensed behavioral health clinician or RD preferred, experience with eating disorders preferred.
3w
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Utilization Physician Reviewer
Tampa, Florida, United States
RemotePart Time
5+ YOEDoctorate (MD/DO) with medical board license, 5 years clinical experience, 1 year education experience; performs observation and secondary reviews, collaborates with case management and clinical providers, and uses Cerner and Microsoft Teams.
Microsoft Teams, Cerner
1mo
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Utilization Management Specialist
Daytona Beach, Florida, United States
OnsiteFull Time
High school diploma/GED; experience with healthcare quality metrics, value-based contracts, or insurance functions; knowledge of HEDIS and care gap reporting preferred; strong communication, documentation, and Excel skills; valid Florida driver's license and background screening required.
Electronic Medical Records (EMR), Microsoft Excel
1w
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Utilization Management Reviewer
Jacksonville, Florida, United States
OnsiteFull Time
1+ YOERequires RN or LPN Florida license or Master's in psychology/human services; 1–3 years behavioral health experience; experience reviewing records, strong communication, and ability to interact with patients on locked inpatient units.
2w
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Utilization Review Nurse
Miami, Florida, United States
RemoteFull Time
2+ YOECurrent Florida RN or LPN license, 2+ years clinical experience and 2–4 years UM/healthcare administration experience preferred, proficiency with EMRs and Microsoft Office, familiarity with InterQual/MCG and medical necessity criteria.
EMR, UM platforms, Microsoft Outlook, Microsoft Excel, Microsoft Word
4d
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Utilization Review Clinician
Miami or United States
HybridFull Time
1+ YOEMaster's in related field required, 1+ year insurance authorization/managed care experience, licensed behavioral health clinician or RD, experience with clinical documentation and payor advocacy.
2mo
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Utilization Management Program Manager-RN
Arizona or Arkansas or Connecticut or Florida or Georgia or Idaho or Indiana or Iowa or Kansas or Kentucky or Louisiana or Michigan or Mississippi or Missouri or Montana or Nebraska or Nevada or New Hampshire or New Mexico or North Carolina or Oklahoma or Oregon or Pennsylvania or South Carolina or South Dakota or Tennessee or Texas or Utah or Virginia or West Virginia or Wisconsin
RemoteFull Time
5+ YOEUnencumbered Oregon RN within 90 days, 1 year clinical nursing plus 4 years health-plan utilization management, experience with managed care, data analysis, quality management, and electronic documentation.
Microsoft Office, EPIC, Clinical Care Advanced
1d
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Medical Director Utilization Management Oncology
Cerritos or California or Nevada or Arizona or Oregon or Florida
$275k-$325k/yr RemoteFull Time
5+ YOEMedical degree (MD or DO) and oncology board certification; minimum 5 years clinical oncology experience and 2+ years utilization management experience; strong analytical and communication skills; ability to review treatment appropriateness.
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