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Utilization review nurse jobs in Coral Springs, FL

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  • Functional Medicine Nurse Practioner

    Centner Wellness & Spa

    Utilization review nurse job in Miami, FL

    Functional Medicine Nurse Practitioner Company: Centner Wellness Job Type: Full-Time At Centner Wellness, we're more than a wellness center-we're a hub of transformation, innovation, and results-driven care. We combine the best of functional medicine, advanced therapies, and personalized attention to help clients achieve true health from the inside out. We're growing fast and seeking a passionate Functional Medicine Nurse Practitioner to join our energetic, purpose-driven team. The Role As a Functional Medicine NP at Centner Wellness, you'll provide whole-person care that blends functional medicine principles with modern therapies. You'll guide patients on their wellness journey, helping them uncover root causes, optimize health, and feel their best. Responsibilities Conduct in-depth patient assessments, including medical history, physical exams, and functional diagnostics Develop individualized treatment plans integrating functional and conventional medicine Educate and coach patients on lifestyle, nutrition, supplementation, and stress management Collaborate with physicians, health coaches, and the clinical team for coordinated care Order and interpret advanced lab testing, adjusting plans as needed Recommend evidence-based supplements, therapies, and interventions tailored to patient needs Document patient care with accuracy and attention to detail Stay ahead of emerging research in functional and integrative medicine Actively contribute to protocols, team training, and quality initiatives Qualifications Master's degree or higher in Nursing with specialization as a Family or Adult Nurse Practitioner Active, unrestricted Nurse Practitioner license in Florida National certification (AANP, ANCC, or equivalent) Required: prior experience in functional medicine or integrative healthcare Strong knowledge of functional principles: nutrition, supplementation, root-cause medicine, mind-body connection Excellent clinical judgment, communication, and patient education skills Team-oriented mindset with a passion for delivering exceptional, compassionate care Why Join Us? Be part of a leading-edge wellness brand at the intersection of beauty, health, and longevity Work in a collaborative, supportive, and energetic environment in the heart of Brickell Play a key role in transforming lives through functional and holistic medicine Opportunities for growth, continued learning, and innovation Serious inquiries only-functional medicine experience is required. Please send cover letter explaining your experience with functional medicine and holistic approach.
    $38k-63k yearly est. 2d ago
  • Utilization Review Staff Job ID-1638446

    North Shore Medical Center 4.4company rating

    Utilization review nurse job in Miami, FL

    Job Description We are North Shore Medical Center Our primary function is to offer continuous nursing, medical, and other health and social services on a 24-hour basis, under physician-directed care and RN supervision. We service a multitude of patients and their families across our vast network, while remaining committed to the professional development of our staff, the functional improvement of our patients, and the cultivation of strong partnerships within our communities. WHAT WE OFFER An essential/stable and growing company with many opportunities for training and advancement within the medical field that all employees and team members (including Full-Time and Part-Time) can benefit from. Hourly pay is negotiable based on experience. Comprehensive Employee Benefits: Full-Time employees are eligible for various plans for medical, dental, and vision insurance. PRIMARY RESPONSIBILITIES Conduct thorough reviews of clinical documentation to determine the medical necessity of services rendered. Analyze data related to patient care and outcomes to identify areas for improvement. Provide support in the development of clinical guidelines and protocols for utilization management. Maintain up-to-date knowledge of medical terminology, coding (CPT, ICD-9, ICD-10), and healthcare regulations. Engage in discharge planning and case management to facilitate patient transitions. Skills Conduct thorough reviews of clinical documentation to determine the medical necessity of services rendered. Analyze data related to patient care and outcomes to identify areas for improvement. Provide support in the development of clinical guidelines and protocols for utilization management. Maintain up-to-date knowledge of medical terminology, coding (CPT, ICD-9, ICD-10), and healthcare regulations. Engage in discharge planning and case management to facilitate patient transitions. Education & Requirements Experience in Utilization Management Previous experience working in Acute Care, or Behavioral health Ability to Communicate in English BLS required We are committed to creating: A safe and respectful work environment. We want our team members to enjoy the same sense of care and belonging that we provide for our patients. Teams that celebrate, empower, and uplift people. A supportive, inclusive culture, where people flourish and thrive is one that everyone embraces and deserves. A culture of inclusivity and kindness. Don't just treat people how you want to be treated: treat them how they want to be treated. We believe, "If you can be anything in this world, be kind". Must be able to pass Background and Drug Test screenings.
    $57k-69k yearly est. 5d ago
  • Utilization Reviewer

    Larkin Community Hospital 4.5company rating

    Utilization review nurse job in Hialeah, FL

    (1) Full-Time Utilization Reviewer: Monday through Friday 8:30 a.m. - 5:00 p.m. Qualifications: Clinical Background with 2 years of UR experience RN (or) Master level Clinician CPI Certification required Experience in Psychiatric facility preferred Bilingual (English/Spanish) preferred 3-5 years' experience of Mental Health and Substance Abuse in an Inpatient setting. EQUAL OPPORTUNITY EMPLOYER Larkin Behavioral Health Services is an Equal Opportunity Employer committed to nondiscrimination on the basis of race, color, religion, national origin, sex, sexual orientation, gender status, marital status, age, disability, or covered veteran's status consistent with applicable federal and state laws.
    $53k-66k yearly est. Auto-Apply 60d+ ago
  • Utilization Review Registered Nurse

    Mount Sinai Medical Center of Miami Beach 4.2company rating

    Utilization review nurse job in Hialeah, FL

    As Mount Sinai grows, so does our legacy in high-quality health care. Since 1949, Mount Sinai Medical Center has remained committed to providing access to its diverse community. In delivering an unmatched level of clinical expertise, our medical center is committed to recruiting and training top healthcare workers from across the country. We offer the latest in advanced medicine, technology, and comfort in 12 facilities across Miami-Dade (including our 674-bed main campus facility) and Monroe Counties, with 38 medical services, including cancer care, 24/7 emergency care, orthopedics, cardiovascular care, and more. Mount Sinai takes pride in being South Florida's largest private independent not-for-profit hospital,dedicated to continuing the training of the next generation of medical pioneers. Culture of Caring: The Sinai Way Our hardworking, tight-knit community of more than 4,000 dedicated employees fosters an environment of care and compassion. Each member plays a vital role in our collective mission to deliver excellent healthcare through innovation, education, and research. At Mount Sinai, we take pride in our achievements, aiming to be a beacon of quality healthcare in South Florida. We welcome all healthcare professionals to join our thriving community and contribute to our pursuit for clinical excellence. Position Responsibilities: * Responsible to initiate and monitor service utilization including hospital, sub-acute, and post acute care utilized by participants. * Works with acute, sub-acute and post acute providers to ensure medical care provided is at the appropriate level for the current needs of the participant and proactively works with providers to make the changes needed to ensure the participants care needs are continually met. * Identifies reports and resolves actual or potential delays in service and assures appropriate use of resources * Development of plan of care for participants in collaboration with family, participant, caregiver, facilities and interdisciplinary team to facilitate a timely and safe discharge. * Attends medical rounds and/or care conferences in the hospital, nursing homes, or other in-patient care settings to evaluate the length of stay and utilization. * Works with case management or discharge planning facilities to assist in discharge planning or care transitions in a timely and safe manner * Makes routine visits to nursing home, assisted living facilities, hospitals, group homes and other home settings to assist in care coordination and ensure the participant is receiving the care designated in the plan of care * Assists participants, families and caregivers with End of Life Care needs * Complete the Department of Elder affairs 703B assessment as needed on participants * As needed conducts in person comprehensive initial and on going nursing assessments. * Counsels participants and families regarding health education, preventative health and chronic condition needs. * Provides on-call coverage on a rotating basis with other staff to troubleshoot, advise and coordinate participant care. * Covers for the Clinic Manager, Home Care Coordinator and/or Center Manager as needed. * Responds to diagnostic data and initiates appropriate action or intervention. Qualifications: * Current RN Licensure in State of Florida. BLS and CPR required. * Graduated from accredited school of registered nursing., * One year clinical experience required. Experience in utilization review and/or case management in managed care, workers compensation or other health care setting is preferred. Geriatric physician office, or other case management experience is acceptable. Benefits: We believe in the physical and mental well-being of our employees and are committed to offering comprehensive benefits that fit their personal needs. Our robust employee benefits package includes: * Health benefits * Life insurance * Long-term disability coverage * Healthcare spending accounts * Retirement plan * Paid time off * Pet Insurance * Tuition reimbursement * Employee assistance program * Wellness program * On-site housing for selected positions and more!
    $56k-71k yearly est. 60d+ ago
  • Utilization Review RN

    Healthcare Support Staffing

    Utilization review nurse job in Fort Lauderdale, FL

    HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career! Job Description Are you an experienced Registered Nurse with Utilization Review or Concurrent Review experience looking for a new opportunity with a prestigious Managed Care Company? Do you want the chance to advance your career by joining a rapidly growing company? If you answered “yes" to any of these questions - this is the position for you! Daily Responsibilities: Conducts pre-admission, concurrent and retrospective acute care, sub-acute, hospice, qualification of transitional care and long-term care needs for medical necessity Perform case reviews and complete all required documentation in appropriate database Collaborate with primary or attending physician, case managers, patient and/or family to provide continuity and quality of care in the most cost-effective manner. Timely completion of admission reviews (within 48-hours for weekday, 72-hours for weekend) Provide outpatient or pharmacy services utilization review Hours for this Position: M-F 8:00am to 5:00pm Requirements: Current Florida RN License 2+ years in recent medical/surgical or critical care experience 3+ years of Utilization Review / Case Management experience Strong reasoning ability: define problems, collect data, establish facts, and draw conclusions Advantages of this Opportunity: Competitive salary ($30/hr. to $32/hr.) Permanent position Benefits offered, Medical, Dental, and Vision Fun and positive work environment Interested in being considered? If you are interested in being considered for this position, PLEASE click the APPLY NOW button! Additional Information
    $30-32 hourly 60d+ ago
  • Utilization Management Nurse

    Solis Health Plans, Inc.

    Utilization review nurse job in Doral, FL

    About us: Solis Health Plans is a new kind of Medicare Advantage Company. We provide solutions that are more transparent, connected and effective for both our members and providers. Solis was born out of a desire to provide a more personal experience throughout all levels of the healthcare journey. Our team consists of expert individuals that take pride in delivering quality service. We believe in a culture that collaborates and supports one another, and where success is interlinked and each employee is valued. Please check out our company website at ************************ to learn more about us! **Bilingual in English and Spanish is required** Full benefits package offered on the first on the month following date of hire including: Medical, Dental, Vision, 401K plan with a 100% company match! Our company has doubled size and we have experienced exponential growth in membership from 2,000 members to over 10,000 members! Join our winning Solis Team! Position is fully onsite Monday-Friday. Location: 9250 NW 36th St, Miami, FL 33178. Position Summary: Under the supervision of the Health Services Director, the Utilization Management Nurse (LPN or RN) uses a multidisciplinary approach to organize, coordinate, monitor, evaluate, create and manage organization determinations and authorizations. These service requests will focus on selected complex medical and psychosocial needs of Solis Health Plans members. The UM Nurse is responsible for assuring the receipt of high quality, cost efficient medical outcomes for enrollees. This role works with Medical Directors, Authorization Coordinators and Service Coordinators to perform first level review to pre-certify elective services, procedures and tests utilizing established Care Coordination polices and protocols, Solis Health Plans benefit criteria, applicable regulatory review criteria and nationally accepted criteria for medical necessity determination. Main Key Responsibilities: Conduct concurrent and retrospective utilization review for inpatient, observation or SNF services. Conducts clinical reviews of proposed services against appropriate criteria/guidelines to determine medical necessity, benefit eligibility, and network contract status. Work with Medical Directors, Program Leadership and Solis Health Plans Provider Relations Teams to identify and mitigate facility barriers associated with the ability to make timely decisions. Identify, align and utilize health plan and community resources that impact high-risk/high cost care. Act as liaison between assigned facilities, members/families, and Solis Health Plans. Clarify policies/procedures and member benefits as needed. Authorizes services, coordinates care, and ensures timeliness and coordination of healthcare services, in compliance with department and regulatory standards, seeking supplemental services when appropriate or when needed. Assess enrollee needs and monitor progress toward goals at all times, communicating findings and status with members of the enrollee's primary care team. Ensure optimal delivery of safe quality health care to members, while maximizing resources and containing costs, and facilitate continual patient-centered and outcome-driven health performance improvement activities. Review enrollees with the Medical Directors and Primary Care Teams and advocates for Administration Exception considerations as appropriate. Facilitate communications between the facility, providers, and the PCT in order to effect and influence a safe and effective discharge plan and care plan for the enrollee. Qualifications: Graduate from an accredited school of nursing, or Bachelors (or advanced) degree in nursing. Active and unrestricted licensure as a Registered Nurse in Florida. A minimum of three to five years clinical experience as a Registered Nurse in a clinical setting required. 2 years' experience as a Utilization Management nurse in a managed care payer preferred. One year experience as a case manager in a payer or facility setting highly preferred. Discharge planning experience highly preferred. What Sets Us Apart: Join Solis Health Plans as a Utilization Management Nurse and become a catalyst for positive change in the lives of our members. At Solis, you will be part of a locally rooted organization deeply committed to understanding and serving our communities. If you are eager to embark on a purpose-driven career that promises growth and the chance to make a significant impact, we encourage you to explore the opportunities available at Solis Health Plans. Join us and be the difference!
    $48k-65k yearly est. Auto-Apply 57d ago
  • Utilization Management Professional

    Integrated Resources 4.5company rating

    Utilization review nurse job in Miami, FL

    Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing. Job Description Title: Utilization Management Professional Location: Miami FL 33126 Duration: 6 months (Contract to Hire) Responsibilities: · Under general supervision by management, and in collaboration with Medical Directors and other members of the clinical team, gathers and synthesizes clinical information in order to authorize services. · Reviews health care services to determine consistency with contract requirements, coverage policies and evidence-based medical necessity criteria; collects and analysis utilization information; assists with program processes for transitions across levels of care including discharge planning and ambulatory follow up activity. · Serves as an expert resource on coverage policies, covered benefits, and medical necessity criteria. Essential Functions: - · Develops and manages new enrolee transitions and those involving a change in provider relationships. · Develops and implements transition plans, as indicated, to ensure continuity of care. · Negotiates and documents single case agreements according to the company's procedures. · Reviews planned, in process, or completed health care services to ensure medical necessity and effectiveness according to evidence-based criteria. · Proposes alternatives when the requested services do not meet medical necessity criteria or are outside the contracted network. · As assigned and based on credentials, monitors and reviews specialized requests and treatment records such as Treatment Record Forms. · In conjunction with providers and facilities, identifies, develops and monitors discharge plans. Collaborates with the Care Coordination Team to implement support for transitions in care. Facilitates timely sharing of enrolees clinical information (such as previous treatment, medications, and planned care) in order to promote continuity of care. · Provides information to enrolees, providers, and internal staff regarding covered and non-covered benefits, community resources, agency programs, and company policies and procedures and criteria. Interacts with Medical Directors and Physician Advisors to provide case information and discuss clinical and authorization questions and concerns regarding specific cases. · Assures that case documentation for each decision is complete, including related correspondence. - Participates in Care Coordination Team and utilization management activities, including collaboration with other staff on enrolee cases, and performing data collection, tracking, and analysis. · Maintains an active work load in accordance with performance standards. · Works with community agencies as appropriate. · Participates in network development including identification and recruitment of quality providers as needed. · Advocates for the enrolee to ensure health care needs are met. Interacts with providers in a professional, respectful manner. · Provides coverage of Nurse Line and/or Crisis Line as requested or required for position. Requirements/Certifications: · This Dept. is in growth mode. · Hours of operation for the Dept.: M- F 8m - 7p. · Hours for this role: 8:00a - 4:30p. · No weekends. · This positon is 98% telephonic. · Selected candidate will have at least 3-5 years of experience in a Psychiatric Inpatient Setting or 3-5 years of Health Plan or 3-5 years of Managed Behavioural Health experience Utilization Reviews experience. · Correctional facility experience WILL NOT be viewed as inpatient experience. · There will be rounds with a Doctor for 15 mins every day. · Travel maybe required to a local hospital with a mileage rate of $0.54/mile. · Training will be 3 - 4 weeks long that will include Code of Conduct, Systems App and Shadowing. Credentialing Paperwork will be completed during training. Required License: · LCSW, LCMFC, LMHC, LMFT, LCPC or RN. If you submit an RN, then a Bachelor Degree is required. The Master Degree is required for all other licensing. If you are not interested in looking at new opportunities at this time I fully understand. I would in that case be appreciative of any referrals you could provide from your network of friends and colleagues in the industry. We do offer a referral bonus that I'd be happy to extend to you if they turn out to be a great fit for my client. Additional Information Kind Regards Sumit Agarwal 732-902-2125
    $48k-62k yearly est. 60d+ ago
  • Telephonic Nurse Case Manager II

    Carebridge 3.8company rating

    Utilization review nurse job in Miami, FL

    Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Hours: Monday - Friday 9:00am to 5:30pm EST and 1 late evening 11:30am to 8:00pm EST. * This position will service members in different states; therefore, Multi-State Licensure will be required. This position requires an on-line pre-employment skills assessment. The assessment is free of charge and can be taken from any PC with Internet access. Candidates who meet the minimum requirements will be contacted via email with instructions. In order to move forward in the process, you must complete the assessment within 48 hours of receipt and meet the criteria. The Telephonic Nurse Case Manager II is responsible for care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically. How you will make an impact: * Ensures member access to services appropriate to their health needs. * Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment. * Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements. * Coordinates internal and external resources to meet identified needs. * Monitors and evaluates effectiveness of the care management plan and modifies as necessary. * Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans. * Negotiates rates of reimbursement, as applicable. * Assists in problem solving with providers, claims or service issues. * Assists with development of utilization/care management policies and procedures. Minimum Requirements: * Requires BA/BS in a health-related field and minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. * Current, unrestricted RN license in applicable state required. * Multi-state licensure is required if this individual is providing services in multiple states. Preferred Capabilities, Skills and Experiences: * Case Management experience. * Certification as a Case Manager. * Minimum 2 years' experience in acute care setting. * Managed Care experience. * Ability to talk and type at the same time. * Demonstrate critical thinking skills when interacting with members. * Experience with (Microsoft Office) and/or ability to learn new computer programs/systems/software quickly. * Ability to manage, review and respond to emails/instant messages in a timely fashion. For candidates working in person or virtually in the below locations, the salary* range for this specific position is $76,944 to $126.408. Locations: Colorado; New York; New Jersey In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
    $76.9k-126.4k yearly Auto-Apply 60d+ ago
  • Telephonic Nurse Case Manager II

    Elevance Health

    Utilization review nurse job in Miami, FL

    Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Hours: Monday - Friday 9:00am to 5:30pm EST and 1-2 late evenings 11:30am to 8:00pm EST. * This position will service members in different states; therefore, Multi-State Licensure will be required. This position requires an on-line pre-employment skills assessment. The assessment is free of charge and can be taken from any PC with Internet access. Candidates who meet the minimum requirements will be contacted via email with instructions. In order to move forward in the process, you must complete the assessment within 48 hours of receipt and meet the criteria. The Telephonic Nurse Case Manager II is responsible for care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Performs duties telephonically. How you will make an impact: * Ensures member access to services appropriate to their health needs. * Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment. * Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements. * Coordinates internal and external resources to meet identified needs. * Monitors and evaluates effectiveness of the care management plan and modifies as necessary. * Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans. * Negotiates rates of reimbursement, as applicable. * Assists in problem solving with providers, claims or service issues. * Assists with development of utilization/care management policies and procedures. Minimum Requirements: * Requires BA/BS in a health-related field and minimum of 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background. * Current, unrestricted RN license in applicable state required. * Multi-state licensure is required if this individual is providing services in multiple states. Preferred Capabilities, Skills and Experiences: * Case Management experience. * Certification as a Case Manager. * Minimum 2 years' experience in acute care setting. * Managed Care experience. * Ability to talk and type at the same time. * Demonstrate critical thinking skills when interacting with members. * Experience with (Microsoft Office) and/or ability to learn new computer programs/systems/software quickly. * Ability to manage, review and respond to emails/instant messages in a timely fashion. For candidates working in person or virtually in the below locations, the salary* range for this specific position is $76,944 to $126,408. Locations: Colorado; New York; New Jersey In addition to your salary, Elevance Health offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate, non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender, race, or any other category protected by federal, state, and local pay equity laws. * The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. Even within the range, the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is considered to be wages or compensation until such amount is earned, vested, and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus, commission, benefits, or any other form of compensation and benefits that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company's sole discretion, consistent with the law. Job Level: Non-Management Exempt Workshift: Job Family: MED > Licensed Nurse Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health. Who We Are Elevance Health is a health company dedicated to improving lives and communities - and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve. How We Work At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business. We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few. Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws. Elevance Health is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact ******************************************** for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.
    $76.9k-126.4k yearly 10d ago
  • Utilization Management Coordinator (IDD)

    Independent Living Systems 4.4company rating

    Utilization review nurse job in Miami, FL

    We are seeking a Utilization Management Coordinator (IDD) to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations. About the Role: The Utilization Management Coordinator (IDD) plays a critical role in ensuring that individuals with intellectual and developmental disabilities receive appropriate, timely, and cost-effective health care services. This position involves coordinating and reviewing service authorizations, monitoring care plans, and collaborating with healthcare providers, families, and care teams to optimize service delivery. The coordinator will analyze clinical data and utilization trends to support decision-making and compliance with regulatory requirements. By managing utilization processes effectively, this role helps to balance quality care with resource stewardship, ultimately improving health outcomes for the IDD population. The coordinator also serves as a liaison between various stakeholders to facilitate communication and resolve any issues related to service utilization and care coordination. Minimum Qualifications: Associate's degree in nursing, social work, health administration, or a related field. At least two years of experience in utilization management, care coordination, or case management within a healthcare or IDD service setting. Strong knowledge of intellectual and developmental disabilities and related healthcare services. Familiarity with healthcare regulations, utilization review processes, and managed care principles. Proficiency in electronic health records (EHR) systems and data management tools. Relevant experience may substitute for the educational requirement on a year-for-year basis. Preferred Qualifications: Bachelor's degree in relevant field such as public health, social work, or healthcare administration. Certification in Utilization Review (e.g., Certified Professional in Utilization Review) or Case Management. Experience working directly with individuals with intellectual and developmental disabilities and their families. Knowledge of Medicaid waiver programs and other funding sources for IDD services. Responsibilities: Review and authorize service requests for individuals with intellectual and developmental disabilities in accordance with established clinical guidelines and policies. Collaborate with healthcare providers, case managers, and families to ensure that care plans are appropriate, comprehensive, and aligned with individual needs. Monitor ongoing service utilization to identify trends, gaps, or potential overuse and recommend adjustments to care plans as necessary. Maintain accurate documentation and records of utilization reviews, authorizations, and communications to ensure compliance with regulatory standards. Participate in interdisciplinary team meetings and contribute to quality improvement initiatives focused on enhancing care coordination and service delivery.
    $41k-55k yearly est. Auto-Apply 60d+ ago
  • Nurse Manager - Case Management - FT - Days - MHM

    Memorial Healthcare System 4.0company rating

    Utilization review nurse job in Miramar, FL

    At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience. Summary: Assumes 24-hour accountability for managing the functions of Access, Care Coordination, and Discharge Planning. With the Manager - Social Work, serves as the central resource to the Director - Case Management to develop strategies which are efficient, effective, timely, patient-centered, and support appropriate financial reimbursement. To meet accountabilities of the Care Management Dashboard, collaborates with all disciplines, departments, payers, system partners, vendors, and community agencies to optimize clinical outcomes within best practice, ethical, legal, and regulatory parameters. Responsibilities: Performs semi-annual (minimally) mock surveys, tracer reviews, Life Safety and Safety Assessments of healthcare facilities as part of the compliance process. Performs in-depth building tours using the EC/LS compliance tracking tool and Bluebeam. Assists with progress and compliance of survey results. Provides comprehensive report to senior leadership.Responsible for the Environment of Care program designed to ensure the safety of all building occupants. Includes chairing the regularly scheduled Environment of Care meetings, annual revision of EOC management plans, conducting drills, organization-wide collection of information about deficiencies and opportunities for improvement, and monitoring Life Safety, Fire Management, Security, Utility Management, Emergency Management, and Occupational Work Hazards. Reports regularly to senior leadership.Responsible for intervention whenever environmental conditions pose an immediate threat to life. Ensured ultimate authority for actions required under these circumstances.Participates and or coordinates completion of any risk assessment/ILSM due to ongoing construction projects. Regularly audits ICRA and ILSM documents for compliance and tours projects regularly with project managers.Conducts quarterly inspections of facility kitchens utilizing the Joint Commission checklist. Conducts monthly inspections of leased kitchen space within the facility and on the campus. Reports findings and action items/completion. Reports regularly to senior leadership.Assists with the compliance and readiness of all Environment of Care, Life Safety, and Emergency Management directives set forth by the Authority Having Jurisdiction (AHJ), TJC, AHCA, CMS and all other regulatory agencies. Ensures regulatory updates from these agencies are disseminated to leaders and team appropriately.Continuously strives to improve Safety, Fire Safety and Environment of Care programs through ongoing education and orientation.Conducts quarterly inspections of the campus grounds. Assists with progress and compliance of survey results. Reports regularly to senior leadership.Coordinates and/or participates in environmental tours, mock surveys, and tracer reviews as part of the compliance process. Develops action plans to correct any deficiencies that may be identified in order ensure regulatory compliance.Works with other managers to initiate appropriate actions and recommendations, based on analysis of incident reports and other information. Ensures issues, chosen by the EC Committee, are monitored and the results reported to that committee.Coordinates, attends and assists in the evaluation of Operating Room surgical fire drills (to include Surgeon and Anesthesia) at least annually. Assists with education as needed.Revises and maintains EC/LS compliance tracking tool. Regularly verifies documentation compliance either electronically or in binders, necessary for the successful completion of LS and EC surveys by the Joint Commission, CMS, AHCA, City of Hollywood and Broward County, or any accrediting agency. Meet with Facilities/Plant Operations Directors regularly to discuss deficiencies.Works with responsible individuals in conducting necessary drills that will improve the safety and security of the hospital such as infant abduction drills, and emergency management drills that are based from a completed HVA, etc.Assists Property Management in complying with TJC Environment of Care and Life Safety requirements for Medical Office Buildings under the Memorial Regional hospital licensure. Competencies: ACCOUNTABILITY, CUSTOMER SERVICE, EFFECTIVE COMMUNICATION, HEALTHCARE REGULATORY ENVIRONMENT, LEADING BY COACHING, LEADING CHANGE INITIATIVES, MANAGING PEOPLE, PATIENT AND FAMILY CENTERED CARE, RESPONDING TO CHANGE, STANDARDS OF BEHAVIOR Education and Certification Requirements: Associates (Required) Registered Nurse Compact License (RN LICENSE COMPACT) - Compact RN Multistate, Registered Nurse License (RN LICENSE) - State of Florida (FL) Additional Job Information: Complexity of Work: Responsible for day-to-day oversight and coordination of case management and discharge planning functions ensuring patient care meets quality and efficiency standards while aligning with regulatory requirements. This role requires an understanding of payer guidelines and working closely with multi-disciplinary teams to optimize patient flow. Requires critical thinking and effective communication (verbal and written) skills, decisive judgment, and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action. Knowledge of State and Federal regulations governing discharge planning conditions of participation, hospital information systems (e.g., logician and IDX), staff development techniques, and performance improvements processes. Strong background in clinical decision making, medical criteria, and discharge planning. Must be proficient with Interqual or Milliman guidelines and use. Proficient in process improvement, and performance monitoring. Required Work Experience: Minimum of three (3) years of case management experience and, at least, two (2) years of leadership experience within case management. Other Information: Additional Education Info: Graduate of an accredited Registered/Professional Nursing program or a Bachelor's degree in Nursing (BSN).Additional Certification Info: Certification in Case Management preferred. Working Conditions and Physical Requirements: Bending and Stooping = 0% Climbing = 0% Keyboard Entry = 80% Kneeling = 0% Lifting/Carrying Patients 35 Pounds or Greater = 40% Lifting or Carrying 0 - 25 lbs Non-Patient = 60% Lifting or Carrying 2501 lbs - 75 lbs Non-Patient = 0% Lifting or Carrying > 75 lbs Non-Patient = 0% Pushing or Pulling 0 - 25 lbs Non-Patient = 60% Pushing or Pulling 26 - 75 lbs Non-Patient = 60% Pushing or Pulling > 75 lbs Non-Patient = 0% Reaching = 60% Repetitive Movement Foot/Leg = 0% Repetitive Movement Hand/Arm = 80% Running = 0% Sitting = 80% Squatting = 0% Standing = 80% Walking = 80% Audible Speech = 80% Hearing Acuity = 80% Smelling Acuity = 0% Taste Discrimination = 0% Depth Perception = 80% Distinguish Color = 80% Seeing - Far = 60% Seeing - Near = 80% Bio hazardous Waste = 60% Biological Hazards - Respiratory = 60% Biological Hazards - Skin or Ingestion = 60% Blood and/or Bodily Fluids = 60% Communicable Diseases and/or Pathogens = 60% Asbestos = 0% Cytotoxic Chemicals = 0% Dust = 60% Gas/Vapors/Fumes = 60% Hazardous Chemicals = 60% Hazardous Medication = 40% Latex = 60% Computer Monitor = 80% Domestic Animals = 60% Extreme Heat/Cold = 40% Fire Risk = 0% Hazardous Noise = 0% Heating Devices = 0% Hypoxia = 0% Laser/High Intensity Lights = 0% Magnetic Fields = 0% Moving Mechanical Parts = 0% Needles/Sharp Objects = 60% Potential Electric Shock = 0% Potential for Physical Assault = 60% Radiation = 0% Sudden Decompression During Flights = 0% Unprotected Heights = 0% Wet or Slippery Surfaces = 60% Shift: Primarily for office workers - not eligible for shift differential Disclaimer: This job description is not intended, nor should it be construed to be an exhaustive list of all responsibilities, skills, efforts or working conditions associated with the job. It is intended to indicate the general nature and level of work performed by employees within this classification. Wages shown on independent job boards reflect market averages, not specific to any employer. We encourage candidates to talk to their Memorial Healthcare System recruiter to discuss actual pay rates, during the hiring process. Memorial Healthcare System is proud to be an equal opportunity employer committed to workplace diversity. Memorial Healthcare System recruits, hires and promotes qualified candidates for employment opportunities without regard to race, color, age, religion, gender, gender identity or expression, sexual orientation, national origin, veteran status, disability, genetic information, or any factor prohibited by law. We are proud to offer Veteran's Preference to former military, reservists and military spouses (including widows and widowers). You must indicate your status on your application to take advantage of this program. Employment is subject to post offer, pre-placement assessment, including drug testing. If you need reasonable accommodation during the application process, please call ************ (M-F, 8am-5pm) or email *******************************
    $52k-70k yearly est. Auto-Apply 60d+ ago
  • Nurse Case Manager

    Center for Family and Child Enrichment 3.8company rating

    Utilization review nurse job in Miami Gardens, FL

    Job Description Cherishing Our Children Since 1977 Helping children and families help themselves to live a better life and build a stronger community. The Center for Family and Child Enrichment (CFCE) is dedicated to help children and their families by providing the right services and solutions based on individual needs. CFCE is constantly evolving to better support our community. CFCE expanded in early 2012 to include a health care center, The Pediatric & Family Health and Wellness Center. The Pediatric & Family Health and Wellness Center, a Federally Qualified Health Center (FQHC), offers an array of preventative health services including but not limited to: general and sick care for adults and children, OB/GYN, dental services, nutrition programs and mental health and substance abuse treatment for children and adults. As a Nurse Case Manager (NCM), you will provide expertise as an educator, consultant, and facilitator. The NCM provides quality patient care via the development, implementation and evaluation of individual patient care plans and patient education sessions. Why join CFCE: Great benefits package, including a Zero (0) cost out of pocket medical plan, 13 Paid Holidays and a competitive Paid Time Off Package Making an invaluable impact in your community Growth and professional development opportunities available Qualify for Public Service Loan Forgiveness We are a tax-exempt organization under section 501(c)(3) of the Internal Revenue Code Some of the Functions Include: Establish communication and collaborative relationships with multidisciplinary healthcare team members. Serve as a liaison between behavioral health and the medical (adult and pediatric) teams to facilitate integration and coordination of care between the two entities. Participate in daily patient care team meetings, training as scheduled, and health team coordination activities. Facilitate the work of the physician -Triage, patient phone calls, and subspecialty appointments. Ensure tracking and follow-up of referrals for laboratory, imaging, and subspecialty services within established timelines. Coordinate subspecialty referrals from appointment scheduling to result follow-up for pediatric and adult care. Complete hospital and emergency room referral and follow-up. Coordinate communication/needs with other entities to assist patients to access resources to address barriers to self-care, such as WIC. Provide health promotion and illness prevention case management for pediatric and adult patient populations (examples include but are not limited to asthma action plans, diet and exercise counseling, ADHD management, transition from pediatric to adult care, diabetes education and hypertension education). Provide patient education, monitoring of health needs, and coordination of community resources. Represent the Agency in health fairs. Plans, prepares and maintains materials for use in educational programs for accuracy and relevance to the target audience. Develop educational materials consistent with evidence-based approaches to improve health literacy and promote self-care. Minimum Education Current State of Florida Licensed Practical Nurse. Certification in BLS and ACLS. Minimum Experience 3 Years of applied clinical experience as a LPN in a health related field or as a Clinical Case Manager or Educator. Skills Needed Proficiency in the use of Microsoft Word, Windows, Microsoft Outlook, Excel and spread sheet applications. Knowledge of audiovisual equipment setup is an advantage. CFCE is a Drug Free Workplace and an Equal Opportunity Employer. Powered by JazzHR PDfOJHyNB2
    $54k-70k yearly est. 28d ago
  • Bilingual Nurse Care Coordinator

    Imagine Pediatrics

    Utilization review nurse job in Fort Lauderdale, FL

    Who We Are Imagine Pediatrics is a tech enabled, pediatrician led medical group reimagining care for children with special health care needs. We deliver 24/7 virtual first and in home medical, behavioral, and social care, working alongside families, providers, and health plans to break down barriers to quality care. We do not replace existing care teams; we enhance them, providing an extra layer of support with compassion, creativity, and an unwavering commitment to children with medical complexity. The primary location for this position is remote in South Florida (Miami or Fort Lauderdale preferred) with monthly travel to Tampa, FL. Expected schedule will be 4x10s (Monday-Thursday or Tuesday-Friday). What You'll Do As a Pediatric Nurse Care Coordinator at Imagine Pediatrics, you are the primary point of contact for our families as you work to deeply know our patients through frequent virtual touchpoints and are the first line of defense when our patients are having a clinical problem. You leverage an integrated technology platform and are complimented by an entire interdisciplinary team including MDs, APPs, social workers, navigators, pharmacists, and dietitians. You will: Provide professional and friendly proactive care and triage for clinical issues. Embed a family centered care philosophy in care delivery. Demonstrate cultural competence and sensitivity as ability to work with culturally diverse populations and seek out additional resources when needed. Transition of care for ED/IP/UC care coordination with clinical providers following discharge. Perform a comprehensive assessment of a patient's clinical, psychosocial, discharge planning and financial needs. Establishes clinical milestones and goals related to these issues. Establish rapport and a relationship with the patient and family in order to understand their needs and expectations and to assist them in setting realistic and mutual goals. Integrate an awareness of cultural factors in the patient/family interview process and elicit clinically relevant cultural information. In conjunction with the physician, the patient and interdisciplinary team, establishes a comprehensive plan of care to appropriately address clinical milestones. Communicate plan of care, including changes and issues related to plan of care to patient/family, physicians and other members of the healthcare team. Gather sufficient information from all relevant sources to determine the effectiveness of the plan of care to assure it is done in an accurate, safe, timely and cost-effective manner. Document all care management assessments and interventions. Refer to Social Worker or Behavioral Health for complex psychosocial and discharge planning issues (per criteria) and ensures appropriate follow-up. Consults with other members of the interdisciplinary team (dietary, pharmacy, etc.) to provide safe discharge as appropriate. Perform other duties as assigned What You Bring & How You Qualify First and foremost, you're passionate and committed to creating the world our sickest children deserve. You want an active role in building a diverse and values-driven culture. Things change quickly in a startup environment; you accept that and are willing to pivot quickly on priorities. In this role, you will need: Licensed RN in at least one state with eligibility to register for other state licensures. Bachelor's in nursing from an accredited university required. Pediatrics experience required in outpatient (primary care and/or subspecialty), home health, complex care, pediatric ICU, emergency medicine, etc. Minimum 1 year care coordination or case management experience preferred. Bilingual Spanish required Familiarity with Medicaid regulations and services a plus Value Based Care (VBC) experience a plus Virtual care experience a plus What We Offer (Benefits + Perks) The hourly rate for this position ranges from $40 - 47 per hour in addition to competitive company benefits package and eligibility to participate in an employee equity purchase program (as applicable). When determining compensation, we analyze and carefully consider several factors including job-related knowledge, skills and experience. These considerations may cause your compensation to vary. We provide these additional benefits and perks: Competitive medical, dental, and vision insurance Healthcare and Dependent Care FSA; Company-funded HSA 401(k) with 4% match, vested 100% from day one Employer-paid short and long-term disability Life insurance at 1x annual salary 20 days PTO + 10 Company Holidays & 2 Floating Holidays Paid new parent leave Additional benefits to be detailed in offer What We Live By We're guided by our five core values: Our Values: Children First. We put the best interests of children above all. We know that the right decision is always the one that creates more safe days at home for the children we serve today and in the future. Earn Trust. We listen first, speak second. We build lasting relationships by creating shared understanding and consistently following through on our commitments. Innovate Today. We believe that small improvements lead to big impact. We stay curious by asking questions and leveraging new ideas to learn and scale. Embrace Humanity. We lead with empathy and authenticity, presuming competence and good intentions. When we stumble, we use the opportunity to grow and understand how we can improve. One Team, Diverse Perspectives. We actively seek a range of viewpoints to achieve better outcomes. Even when we see things differently, we stay aligned on our shared mission and support one another to move forward - together. We Value Diversity, Equity, Inclusion and Belonging We believe that creating a world where every child with complex medical conditions gets the care and support, they deserve requires a diverse team with diverse perspectives. We're proud to be an equal opportunity employer. People seeking employment at Imagine Pediatrics are considered without regard to race, color, religion, sex, gender, gender identity, gender expression, sexual orientation, marital or veteran status, age, national origin, ancestry, citizenship, physical or mental disability, medical condition, genetic information, or characteristics (or those of a family member), pregnancy or other status protected by applicable law.
    $40-47 hourly Auto-Apply 60d+ ago
  • Nursing - Case Manager

    Sh The Palm Beaches Aru 1632-Riviera Beach, Fl

    Utilization review nurse job in Riviera Beach, FL

    Are you ready to take your Travel career to the next level? See places you have not seen before? Ventura's MedStaff tenured Recruiters are here to help you find your ideal contract; with over 50 years of combined experience. Markets have changed, but Ventura MedStaff has maintained a leader in the forefront of Therapy, Allied and Nursing opportunities. Our recruiters are here to help answer your questions and provide you with the most up to date information. Contracts run 8-13 weeks, with 36-40-hour guarantees, flexible start dates, and a mix of schedules. Contact one of our dedicated Recruiters to discuss more details. Ventura MedStaff benefits represent the care and compassion we provide for our clients. • Health, dental, vision, life, disability benefits and 401k • Tax free stipends when applicable • Gym discounts • Weekly pay • $750.00 referral bonus Please apply or contract us at: *********************** or ************
    $47k-69k yearly est. 3d ago
  • Infusion Nurse

    Biomatrix Specialty Pharmacy

    Utilization review nurse job in Coral Springs, FL

    INTRODUCTION BioMatrix is a nationwide, independently-owned infusion pharmacy with decades of experience supporting patients on specialty medication. Our compassionate care team helps patients navigate the often-challenging healthcare environment. We treat our patients like family and get them started on therapy quickly. We work closely with them as well as their family and their healthcare providers throughout the patient journey, staying focused on optimal clinical outcomes. At BioMatrix the heart of our Inclusion, Diversity, Equity, & Access (IDEA) philosophy is the commitment to cultivate a welcoming space where everyone's contributions are acknowledged and celebrated. Our goal is to draw in, develop, engage, and retain talented, high-performing individuals from diverse backgrounds and viewpoints. We believe that both respecting and embracing diversity enriches the experiences and successes of our patients, employees, and partners. Please note that this posting is not associated to any specifically available position. As we can hire for this position based on evolving business needs, applicants may be considered for future opportunities. Schedule & Location: BioMatrix Specialty Infusion Pharmacy is seeking a Part-Time Per Diem Infusion Nurse to see patients in their homes or infusion suites in Broward County, FL. It is anticipated that an incumbent in this role will work in one of the metropolitan-area locations noted in the posting. Work location is subject to change based on business needs. Job Description: A Registered Nurse for Home Infusion inserts, monitors and removes an IV used to give medications, blood products and nutrition to a patient. During the IV therapy, the nurse monitors the patient for adverse reactions and ensures that the tubing, bandages and needle stay in place. When a patient needs blood levels checked, an IV nurse performs a veinous phlebotomy. During the entire IV therapy process, the nurse obtains sets of vital signs, completes the physical assessment and review of systems, documents all patient-related activities and records the medications they use. Provides and coordinates all aspects of staffing services to the patient with the assistance of the Company Directors, Nursing Coordinator and the Director of Nursing. Communicates with the patients to determine problems and/or solutions regarding their treatment. The Per Diem RN also conveys collected documentation from patient to all necessary internal and third-party external staff regarding scheduling and other pertinent patient information. Performs a variety of duties both clinical and nursing notes documentation. This position requires skill in planning, organizing, scheduling and coordinating the delivery of patient care by all staff personnel including but not limited to complete documentation of nursing care and submission of nursing notes. QUALIFICATION REQUIREMENTS * Nursing Degree from an accredited college or university required * IV certification & experience in central line care and management required * Current state RN license in location denoted in posting required * Minimum of two (2) years of RN experience required * Valid state driver's license required * CPR certification required * Home care, critical care, emergency nursing, AIC or hospital discharge planning experience. * Incumbent should have some experience in staffing and should be able to demonstrate the ability to multi-task as well as good communicative and interpersonal skills. * Basic level skill in Microsoft Office (including Word, Excel, PowerPoint, etc.). * Willing to travel to see patients in the homes, and in other health care facilities. * Experience providing customer service to internal and external customers, including meeting quality standards for services, and evaluation of customer satisfaction. QUALIFICATIONS PREFERRED * Bachelor's degree preferred * RN license in other states preferred ESSENTIAL FUNCTIONS AND RESPONSIBILITIES * Demonstrates the basic knowledge and judgment to utilize the nursing process to schedule nursing visits in accordance with RX's and established protocols. * Coordinates SOC and ongoing nursing visits and confirms scheduled visits with both patient and Nursing Agency/RN. * Assures schedule is sent out via email to team members. * Responsible for following up on and entering Therapy Admin reports and emailing to team involved. * Reviews all nurses notes for content and accuracy and completion without omitting necessary information such as drugs given, drug dosing and time of administration. * Continual communication with families, supervisors and field personnel, agencies regarding problems and/or special needs of both the patient. * Responsible to communicate all problems and reportable situations to the referring MD and appropriate MD office administrator and to Biomatrix nursing * Computer functions including but not limited to input, reports, searches, schedules. * Communicates patient/employee information to answering services when necessary. * Has read and understands company compliance paperwork and videotapes. * Performs all duties in accordance with all applicable federal and state laws and with the highest ethical standards. * Coordinates staffing in a timely manner while also adhering to confidentiality and ethics as discussed in the compliance program 100% of the time. * Insert intravenous cannulas; administer prescribed intravenous solutions, medications; monitor & maintain infusion sites & system; evaluate responses to prescribed therapy. * Teach patients & caregivers to perform & monitor administration of Home Infusion as prescribed. * Prepare clinical records, care plans, progress notes for each patient visit. * Coordinate schedule of patient visits & phone calls. * Works in patients place of residence. * Drive as assigned within state. * Prior experience in Home Infusion Therapy is preferred. PICC/Port/Midline experience and certification is preferred. NON-ESSENTIAL FUNCTIONS & RESPONSIBILITIES * Ability to prioritize and handle multiple tasks and projects concurrently. * Must have scheduling flexibility and be able to work extra hours if needed. * Careful attention to detail. * Performs related duties as requested. * Participates in quality assurance activities and audits as directed. KNOWLEDEGE, SKILLS AND ABILITIES REQUIREMENTS * Provides professional nursing care within the department * Coordinates care planning with other disciplines * Provides care that meets the psychosocial, physical general aspects of care * Determines priorities of care based on physical psychosocial needs of patients, as well as factors influencing patient flow through the system * Communicates regarding changes in patient status, symptomatology results of diagnostic studies * Responds quickly accurately to changes in condition or response to treatment * Excellent verbal skills and Good written skills * Excellent Customer Service skills * Must be able to develop caring relationships with their patients and treat them with respect and empathy. * Possess medical-surgical experience or knowledge in phlebotomy and venous access, both of which deal with the collection of blood. * Must be able to work independently, as well as on a team. * Must teach the patient how to properly care for their IV or PICC line and be able to communicate with patients clearly while giving instructions. * Ability to work under high levels of stress, know how to handle critical situations in the home. Communication Skills * Oral Communication - Speaks clearly and persuasively in positive or negative situations; listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings. * Written Communication - Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information. Computer Skills * Become and remain proficient is all programs necessary for execution. PHYSICAL DEMANDS AND WORK ENVIRONMENT * This position requires driving to patient homes and other HC facilities, walking, sitting, standing, kneeling or stooping. * This position requires the use of hands to finger, handle or feel objects and the ability to reach with hands and arms. * This position requires constant talking and hearing. * Specific vision abilities required by this job include close vision and the ability to adjust focus. * This position must occasionally lift and/or move up to 20 pounds * Required to move/lift physical hardware. PHYSICAL DEMANDS The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. If needing a reasonable accommodation within the application process, please contact the BioMatrix People & Culture team at ************************* or ************ x 1425. While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; talk or hear; taste or smell. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus. OTHER * Will participate in legal and ethical compliance training each year. * Will consistently behave in compliance with the BioMatrix, LLC's legal and ethical policies and procedures. * Will abide by the policies of BioMatrix, LLC as set forth in the Compliance Manual. * Will not participate in any conduct considered to be unethical or illegal. EXPECTATION FOR ALL EMPLOYEES Supports the organization's mission, vision, and values by exhibiting the following behaviors: integrity, dedication, compassion, enrichment and enthusiasm, places patients first, is all-in with stacked-hands, and is focused on relentless consistency wins. GENERAL INFORMATION: The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required of personnel so classified. The incumbent must be able to work in a fast-paced environment with demonstrated ability to juggle and prioritize multiple, competing tasks and demands and to seek supervisory assistance as appropriate. Incumbents within this position may be required to assist or find appropriate assistance to make accommodations for disabled individuals in order to ensure access to the organization's services (may include: visitors, patients, employees, or others). All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
    $38k-63k yearly est. Easy Apply 31d ago
  • Performance Improvement Nurse, Quality Indicators, FT, 8A-4:30P

    Baptist Health South Florida 4.5company rating

    Utilization review nurse job in Boca Raton, FL

    The purpose of the PI Nurse role is to provide and apply clinical knowledge and expertise, advanced critical thinking, coaching and teaching skills and knowledge of performance improvement tools, techniques and processes to a variety of federally or state mandated and/or hospital driven processes including medical staff peer review, clinical database coordination, team/task force development and facilitation and maintenance of policies and procedures and continuous accreditation readiness. Demonstrates advanced verbal and written skills, good organizational skills and interpersonal skills including ability to analyze data, manage time, prioritize, communicate effectively, and problem solve. Estimated pay range for this position is $73,860 - $104,670 / annually depending on experience. Degrees: * Associates Licenses & Certifications: * Registered Nurse. Additional Qualifications: * 5 years acute care experience * Demonstrated proficiency with MS office word and excel * Demonstrates involvement in Performance Improvement activities Minimum Required Experience: 5 Years
    $73.9k-104.7k yearly 12d ago
  • Wellness Nurse

    Arbor Company 4.3company rating

    Utilization review nurse job in Pompano Beach, FL

    Are you ready to love your job again? Join The Arbor Company and discover a work family where you are treated with respect. We are recognized by our team members as a Great Place To Work and we are honored to be one of only 20 companies on Fortune Magazine's "Best Workplaces in Aging Services" list. Arbor People feel the love every day because we provide: * Free Meal for Each Work Shift * Employee Assistance Program - Wellness Resources for You and Your Family * Paid Time Off for Full Time and Part Time Staff, Plus the Ability to Turn Your PTO Into Cash * Options To Get Paid on Your Own Schedule * Pathways For Growth Opportunities * Student Loan Repayment Assistance & Tuition Assistance * Access To Emergency Financial Assistance * Access To Health, Dental, Vision Insurance & 401K with Employer Matching Contributions Education Requirement: * Must be currently licensed LPN (in good standing). Some of the duties include but are not limited to: Personnel: * Ensure daily Resident Assistant assignment sheets are completed and followed * Provide training and orientation on the floor for new CMA's and nurses * Supervise staff to ensure care delivery is completed per policy and individual resident task sheet * Reassign staff as needed to cover for call ins or changes in census Clinical Oversight: * Participate in daily clinical standup meeting. * Follow up on residents with condition changes with an assessment and documentation and necessary communication to family and physician * Organize clinical information for onsite MD and NPs prior to their visits * Review daily 24-hour communication log for resident changes and follow up charting * Review the HOT Box for any follow up needed and assist the med tech and nurse as necessary * Ensure monthly weights and VS are completed and entered into Quick Mar * Complete quarterly self-med assessments for residents that self-medicate * Review new resident's records for completed information using the checklist * Complete the monthly cycle check in of medications for AL, Bridges and EG and follow up on the discrepancy report * Relieve the day nurse for meal and breaks * Review and approve orders in QuickMar * Make rounds daily in Evergreen and provide any clinical oversight for the EG Director Shift available: Every Friday and Saturday 7a-3:30p. Our people and our residents are at the center of our universe. We can't wait to meet you! Arbor1
    $30k-49k yearly est. 10d ago
  • Nursing - Cath Lab

    Aventura Hospital and Medical Center

    Utilization review nurse job in Aventura, FL

    Are you ready to take your Travel career to the next level? See places you have not seen before? Ventura's MedStaff tenured Recruiters are here to help you find your ideal contract; with over 50 years of combined experience. Markets have changed, but Ventura MedStaff has maintained a leader in the forefront of Therapy, Allied and Nursing opportunities. Our recruiters are here to help answer your questions and provide you with the most up to date information. Contracts run 8-13 weeks, with 36-40-hour guarantees, flexible start dates, and a mix of schedules. Contact one of our dedicated Recruiters to discuss more details. Ventura MedStaff benefits represent the care and compassion we provide for our clients. • Health, dental, vision, life, disability benefits and 401k • Tax free stipends when applicable • Gym discounts • Weekly pay • $750.00 referral bonus Please apply or contract us at: *********************** or ************
    $38k-63k yearly est. 1d ago
  • Nurse

    Sinai Residences

    Utilization review nurse job in Boca Raton, FL

    Sinai Residences seeks a Licensed Practical Nurse Part-Time position- Friday 12-hour shift Who we are: Step into a senior living community where the feel of an opulent resort is infused into every detail. Sinai Residences is the premier, five star senior living facility in Boca Raton, FL, located on the secure, gated, 100-acre Jewish Federation campus. This luxury senior living facility offers sophisticated independent living and assisted living options in a multi-generational setting with innovative amenities and programs where no detail has been compromised. Why Sinai: Sinai Residences is an extraordinary place to work. Here at Sinai Residences you will find yourself as a vital member of our exceptional team committed to providing superior service, compassioned care, and creating a beautiful community. Join a hospitality team committed to making a difference in the way our seniors live their lives every day! Everything we do is based off of our Hospitality Promises. We promise to maintain a well-trained workforce and a safe, modern facility in order to render our residents the best possible care and to provide our employees a secure future. We need you to join our team as a Licensed Practical Nurse: Sinai Residences is seeking a caring and compassionate Licensed Practical Nurse. Our LPN's participate in the planning and coordination of total patient care in conjunction with the RN and the physician's plan of care, and follow the nursing care plan for each patient. Qualifications: 1 year experience as an LPN in a home care setting Current state license as an LPN Graduate of an accredited program of practical nursing Proof of current CPR certification Valid driver's license and reliable transportation Ability to work a flexible schedule and travel locally
    $38k-63k yearly est. Auto-Apply 60d+ ago
  • Performance Improvement Nurse, Quality Indicators, FT, 8A-4:30P

    Baptisthlth

    Utilization review nurse job in Boca Raton, FL

    Performance Improvement Nurse, Quality Indicators, FT, 8A-4:30P-154931Description The purpose of the PI Nurse role is to provide and apply clinical knowledge and expertise, advanced critical thinking, coaching and teaching skills and knowledge of performance improvement tools, techniques and processes to a variety of federally or state mandated and/or hospital driven processes including medical staff peer review, clinical database coordination, team/task force development and facilitation and maintenance of policies and procedures and continuous accreditation readiness. Demonstrates advanced verbal and written skills, good organizational skills and interpersonal skills including ability to analyze data, manage time, prioritize, communicate effectively, and problem solve. Qualifications Degrees:AssociatesLicenses & Certifications:Registered Nurse. Additional Qualifications:5 years acute care experience Demonstrated proficiency with MS office word and excel Demonstrates involvement in Performance Improvement activities Minimum Required Experience: 5 YearsJob NursingPrimary Location Boca RatonOrganization Boca Raton Regional HospitalSchedule Full-time Job Posting Nov 25, 2025, 5:00:00 AMUnposting Date Ongoing Pay Grade R24EOE, including disability/vets
    $38k-63k yearly est. Auto-Apply 13d ago

Learn more about utilization review nurse jobs

How much does a utilization review nurse earn in Coral Springs, FL?

The average utilization review nurse in Coral Springs, FL earns between $42,000 and $75,000 annually. This compares to the national average utilization review nurse range of $47,000 to $89,000.

Average utilization review nurse salary in Coral Springs, FL

$56,000

What are the biggest employers of Utilization Review Nurses in Coral Springs, FL?

The biggest employers of Utilization Review Nurses in Coral Springs, FL are:
  1. Healthcare Support Staffing
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