3w
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Supervisor, Utilization Management
Alaska or Arkansas or Arizona or Colorado or Florida or Hawaii or Iowa or Idaho or Illinois or Kansas or Louisiana or Maryland or Minnesota or Missouri or Montana or Nebraska or Nevada or New Mexico or North Carolina or North Dakota or Oklahoma or Oregon or South Carolina or South Dakota or Tennessee or Texas or Utah or Virginia or District of Columbia or Washington or Wisconsin or Wyoming or Phoenix
$101k-$107k/yr RemoteFull Time
3+ YOE3+ MgmtActive RN license, 3+ years healthcare experience, 3+ years supervisory experience, 2+ years utilization review/case management, U.S. citizenship and favorable DoD background investigation required.
InterQual, Microsoft Office, Microsoft Word, Microsoft Outlook, TriWest Intranet, Internet, International Classification of Diseases, Diagnostic and Statistical Manual of Mental Disorders, Current Procedural Terminology, Healthcare Common Procedural Coding System, American Dental codes
1d
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Utilization Management Nurse
Florida, United States
$71k-$98k/yr RemoteFull Time
3+ YOEActive Florida RN (or LPN) license with no disciplinary action, RN with 3+ years clinical experience (LPN 5+ years), Florida residency, experience in utilization management/authorizations and case management preferred, familiarity with MCG and durable medical equipment review, BSN preferred.
MCG
3w
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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.
1d
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ED Utilization Management RN
Daytona Beach, Florida, United States
$33-$57/hr RemoteFull Time
3+ YOEActive RN license, knowledge of utilization management criteria, 3+ years acute/ED experience, BLS required/preferred, EMR and Microsoft Office proficiency, strong clinical and communication skills.
Electronic Medical Records (EMR), Microsoft Office
3w
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GROUP DIR - UTILIZATION MANAGEMENT
Jacksonville, Florida, United States
OnsiteFull Time
Oversee utilization management across inpatient and outpatient behavioral health services; ensure regulatory compliance, coordinate interdisciplinary treatment planning, manage payer interfaces, and implement performance improvement systems.
1d
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Utilization Management Clinician
Florida, United States
$71k-$106k/yr RemoteFull Time
3+ YOERequires 3+ years nursing or behavioral health experience, active clinical license (RN,LPC,LMFT,LCSW,PMHNP), knowledge of case management, ICD/CPT codes, and ability to document and coordinate care.
ICD, CPT
1mo
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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
1w
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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
2w
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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.
1mo
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Inpatient Utilization Management Specialist
Punta Gorda, Florida, United States
$17-$19/hr OnsitePart Time
2+ YOEHigh school diploma, familiarity with managed care and ASAM criteria, EMR proficiency, strong UM knowledge, ability to pass Level II background and drug screen; 2 years behavioral health experience preferred.
Electronic Medical Records (EMR)
1w
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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.
3w
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Utilization Management Support Technician
Miami, Florida, United States
$22/hr RemoteFull Time
1+ YOEActive national CPhT, 1+ years pharmacy technician experience in PBM/managed care or mail order/specialty pharmacy; experience with claims adjudication and call center work; strong attention to detail and communication skills; Associate's/Bachelor's preferred.
4d
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Utilization Review
Miami, Florida, United States
OnsiteFull Time
2+ YOEValid Florida RN license, associates degree in nursing (bachelor preferred), minimum 2 years utilization review/care management experience in hospital, BLS/clinical knowledge, strong communication and documentation skills.
4d
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Utilization Specialist - Full-Time
Wesley Chapel, Florida, United States
OnsiteFull Time
2+ YOEHigh school diploma or equivalent required; clinical experience or 2+ years working with the population. Preferred clinical degree/licensure; CPR and de-escalation/restraint training required. Experience with utilization management preferred.
4d
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Utilization Review Specialist
Pompano Beach, Florida, United States
$50k-$65k/yr RemoteFull Time
1+ YOEHigh school diploma, 1+ year utilization review experience in psychiatric or chemical dependency settings, strong documentation and communication skills, ability to manage high caseloads, and work independently in a remote environment.
1mo
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RN, Utilization Management | Utilization Management| Variable | PRN
Leesburg, Florida, United States
OnsitePart Time, Temporary
3+ YOECurrent Florida RN license; minimum 3 years experience in utilization review/management or case management; knowledge of utilization guidelines, payer requirements, and regulatory compliance; strong communication and data-analysis skills.
4d
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Utilization Mgmt Case Mgr II
Sarasota, Florida, United States
HybridFull Time
3+ YOEBSN required, FL RN license, 3+ years utilization review and acute care experience, experience with hospital information systems and PC, strong clinical assessment and communication skills.
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.
2d
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Utilization Review Clinician - Behavioral Health
Florida, United States
$27-$49/hr RemoteFull Time
2+ YOEActive RN or independent clinical licensure (LCSW/LMHC/LMFT/LPC/LMHP), Graduate degree (Bachelor's required; Master's for behavioral clinicians), 2+ years related experience, knowledge of medical necessity and utilization management.
3w
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Utilization Review Specialist (Tampa)
Tampa, Florida, United States
$45k-$60k/yr OnsiteFull Time
Manage insurance authorizations, review medical necessity and records, navigate EMRs and payer portals, communicate with clinicians and payors, and track denials; high school diploma and attention to detail required.
EMR, payspan, zelis, Microsoft Word, Microsoft Outlook, Microsoft Excel, Adobe, InterQual, ASAM, LOCUS
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