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  • Medical Review Nurse (RN)- Itemized Bill Review

    Molina Healthcare Inc. 4.4company rating

    Utilization review nurse job in Jacksonville, FL

    Provides support for medical claim and internal appeals review activities - ensuring alignment with applicable state and federal regulatory requirements, Molina policies and procedures, and medically appropriate clinical guidelines. Contributes to overarching strategy to provide quality and cost-effective member care. ESSENTIAL JOB DUTIES: * Facilitates clinical/medical reviews of retrospective medical claim reviews, medical claims and previously denied cases in which an appeal has been made, or is likely to be made, to ensure medical necessity and appropriate/accurate billing and claims processing. * Reevaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of relevant and applicable state and federal regulatory requirements and guidelines, knowledge of Molina policies and procedures, and individual judgment and experience to assess the appropriateness of services provided, length of stay, level of care, and inpatient readmissions. * Validates member medical records and claims submitted/correct coding, to ensure appropriate reimbursement to providers. * Resolves escalated complaints regarding utilization management and long-term services and supports (LTSS) issues. * Identifies and reports quality of care issues. * Assists with complex claim review including diagnosis-related group (DRG) validation, itemized bill review, appropriate level of care, inpatient readmission, and any opportunities identified by the payment integrity analytical team; makes decisions and recommendations pertinent to clinical experience. * Prepares and presents cases representing Molina, along with the chief medical officer (CMO), for administrative law judge pre-hearings, state insurance commissions, and judicial fair hearings. * Reviews medically appropriate clinical guidelines and other appropriate criteria with medical directors on denial decisions. * Supplies criteria supporting all recommendations for denial or modification of payment decisions. * Serves as a clinical resource for utilization management, CMOs, physicians and member/provider inquiries/appeals. * Provides training and support to clinical peers. * Identifies and refers members with special needs to the appropriate Molina program per applicable policies/protocols. REQUIRED QUALIFICATIONS: * At least 2 years clinical nursing experience, including at least 1 year of utilization review, medical claims review, long-term services and supports (LTSS), claims auditing, medical necessity review and/or coding experience, or equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in state of practice. * Experience demonstrating knowledge of ICD-10, Current Procedural Technology (CPT) coding and Healthcare Common Procedure Coding (HCPC). * Experience working within applicable state, federal, and third-party regulations. * Analytic, problem-solving, and decision-making skills. * Organizational and time-management skills. * Attention to detail. * Critical-thinking and active listening skills. * Common look proficiency. * Effective verbal and written communication skills. * Microsoft Office suite and applicable software program(s) proficiency. PREFERRED QUALIFICATIONS: * Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ), or other health care certifications. * Nursing experience in critical care, emergency medicine, medical/surgical or pediatrics. * Billing and coding experience. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $29.05 - $67.97 / HOURLY * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. About Us Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
    $29.1-68 hourly 2d ago
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  • Utilization Review Coordinator

    Sedgwick 4.4company rating

    Utilization review nurse job in Jacksonville, FL

    By joining Sedgwick, you'll be part of something truly meaningful. It's what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there's no limit to what you can achieve. Newsweek Recognizes Sedgwick as America's Greatest Workplaces National Top Companies Certified as a Great Place to Work Fortune Best Workplaces in Financial Services & Insurance Utilization Review Coordinator **PRIMARY PURPOSE** : To assign utilization review requests; to verify and enter data in appropriate system(s); and to provide general support to clinical staff in a team environment. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Accesses, triages and assigns cases for utilization review (UR). + Responds to telephone inquiries proving accurate information and triage as necessary. + Enters demographics and UR information into claims or clinical management system; maintains data integrity. + Obtains all necessary information required for UR processing from internal and external sources per policies and procedures. + Distributes incoming and outgoing correspondence, faxes and mail; uploads review documents into paperless system as necessary. + Supports other units as needed. **ADDITIONAL FUNCTIONS and RESPONSIBILITIES** + Performs other duties as assigned. + Supports the organization's quality program(s). **QUALIFICATIONS** **Education & Licensing** High School diploma or GED required. **Experience** Two (2) years of administrative experience or equivalent combination of experience and education required. Customer service in medical field preferred. Workers compensation, disability and/or liability claims processing experience preferred. **Skills & Knowledge** + Knowledge of medical and insurance terminology + Knowledge of ICD9 and CPT coding + Excellent oral and written communication, including presentation skills + PC literate, including Microsoft Office products + Analytical and interpretive skills + Strong organizational skills + Detail Oriented + Good interpersonal skills + Ability to work in a team environment + Ability to meet or exceed Performance Competencies **WORK ENVIRONMENT** When applicable and appropriate, consideration will be given to reasonable accommodations. **Mental:** Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines **Physical:** Computer keyboarding, travel as required **Auditory/Visual:** Hearing, vision and talking The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time. Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. **If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.** **Sedgwick is the world's leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company's expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see** **sedgwick.com**
    $64k-78k yearly est. 6d ago
  • Utilization Management Reviewer

    Mental Health Resource Center 4.1company rating

    Utilization review nurse job in Jacksonville, FL

    Benefits: Dental insurance Health insurance Paid time off Training & development Vision insurance Benefits/Perks Medical, Dental, and Vision Insurance Life Insurance Disability Insurance 403b PTO Paid Holidays Flexible Spending Account Employee Assistance Program Company Overview Mental Health Resource Center is a not-for-profit Florida corporation that provides a wide range of mental health and behavioral health care services to the community such as 24-hour emergency services, inpatient psychiatric services for children, adolescents, and adults as well as outpatient services such as medication management, case management, and counseling. Job Summary Mental Health Resource Center is looking for a Utilization Management Reviewer to monitor the utilization of clinical services provided at Mental Health Resource Center (MHRC), using predetermined criteria, review of medical records, and regular participation in treatment team meetings. The crisis stabilization units provide services for adults, adolescents, and children. Most patients are admitted involuntarily to the facility via the Baker Act, the mental health act of Florida. The normal length of stay on the unit for patients is typically 3-5 days. Due to the types of services provided, crisis stabilization units are a fast paced working environment and present employees with challenging and rewarding opportunities. Employees work together and support one another in a friendly, team oriented atmosphere. Responsibilities Reviews medical records and attends treatment team meetings to review utilization of resources and the level of care provided. Ensures utilization and level of care are appropriate based on the diagnosis, needs, age and culture of the individual. Carries out appropriate telephone and written communication with insurers and third party payers regarding referrals, admissions, medication changes, discharges and changes in level of care. Coordinates on-site review of medical records with reviewers from third party payers. Documents, updates, and manages patient and provider information using internal electronic records system. Coordinates psychiatric consultations between internal and external providers. Investigates complaints, grievances, and medication variances. Reports findings to Utilization Management Manager and completes necessary follow up. Responds to changing needs of the departments (i.e., program design, forms development, reporting mechanisms, etc).Establishes and maintains effective working relationships with staff members to assure professional interactions. Qualifications In order to be considered candidates must have one of the following: Registered Nurse: Associate Degree in Nursing required. One year experience in psychiatric nursing required. Valid Florida RN License required. OR Licensed Practical Nurse: Graduation from an accredited school of Practical Nursing required. Two years experience in psychiatric nursing required. Valid Florida LPN License required. OR Master's degree in Psychology or Human Services related field required. Three years experience in the mental health field required. UM experience preferred. Requires telephone and person-to-person interactions with individuals with mental illness on locked inpatient units. Excellent communication skills are essential and this individual must be able to interact appropriately with internal and external customers, including families, caregivers, community service providers, supervisory staff and other department professionals. Each employee contributes to the completeness and confidentiality of clinical records by ensuring documentation, paperwork and system entries meet internal and external guidelines for content, accuracy and timeliness. Position Details This is a full time position, Monday through Friday, 7:00am to 3:30pm Renaissance Behavioral Health Systems and Mental Health Resource Center are Equal Opportunity Employers. Background screening and clearance through the Florida Care Provider Background Screening Clearinghouse is required for all positions: ******************************** Thank you for your interest in joining the team at Mental Health Resource Center and Renaissance Behavioral Health Systems. We offer a variety of opportunities in the behavioral health and social services fields. We have locations in Jacksonville and throughout Florida. Employees work together and support one another in a friendly, team-oriented atmosphere that encourages professional growth. We offer an ideal workplace for individuals dedicated to providing care and services that reflect our core values of compassion, integrity, and excellence. Mental Health Resource Center, Inc. (MHRC) is a nonprofit organization that provides a wide range of behavioral health and social services to the community. Included in MHRC's service array are 24-hour emergency services and inpatient psychiatric services for children, adolescents, and adults. Outpatient services include medication management, care coordination, case management, intensive case management team services, counseling, psychosocial rehabilitation, an adult therapeutic family program, state hospital liaison services, mental health court, multidisciplinary forensic teams (MFT), jail-based diversion services, a Co-Responder Program with the Jacksonville Sheriff's Office, the Link-to-Life suicide prevention program, and services that assist individuals in obtaining benefits such as Social Security Income, Social Security Disability Income, Medicaid, food stamps, and housing. In addition, UF Health Jacksonville contracts with MHRC to manage the hospital's adult inpatient psychiatric unit. MHRC also operates eight Florida Assertive Community Treatment (FACT) programs for adults with severe and persistent mental illness, located in Clearwater, Gainesville, Jacksonville, Kissimmee, Rockledge, Tampa, and Winter Haven, as well as a FACT Lite program providing Linking, Advocating, Treating, Transitioning, Empowering & Recovery Support (LATTERS) services in Jacksonville. The two FACT teams located in Jacksonville serve residents of Duval, Clay, and Nassau counties. Renaissance Behavioral Health Systems and Mental Health Resource Center encourage all applicants to take advantage of opportunities for hire, and if internal applicants, transfers, promotions, and advancement, regardless of their race, color, religion, sex, sexual orientation, gender identity or expression, age, handicap, disability, marital status, national origin, veteran status, or genetic information. RBHS and MHRC are Equal Opportunity Employers and Drug Free Workplaces. Background screening and clearance through the Florida Care Provider Background Screening Clearinghouse is required for all positions: ********************************
    $53k-66k yearly est. Auto-Apply 60d ago
  • Formulary Strategy & Utilization Review Pharmacist

    Pharmacy Careers 4.3company rating

    Utilization review nurse job in Jacksonville, FL

    Formulary Strategy & Utilization Review Pharmacist Shape the drug benefit landscape-analyze and optimize medication use. Key Responsibilities: Review prescribing trends and propose cost-saving alternatives. Maintain evidence-based formularies across multiple payers. Conduct retrospective DUR and prepare stakeholder reports. Qualifications: PharmD with managed care, DUR, or pharmacy benefit experience. Strong Excel/data analytics background preferred. Understanding of clinical guidelines and P&T processes. Why Join Us? Join a top-tier managed care team Hybrid flexibility Strategic and data-driven focus
    $54k-64k yearly est. 60d+ ago
  • REGISTERED NURSING CONSULTANT - 64004547

    State of Florida 4.3company rating

    Utilization review nurse job in Jacksonville, FL

    Working Title: REGISTERED NURSING CONSULTANT - 64004547 Pay Plan: Career Service 64004547 Salary: $75,050 - 82,950 Total Compensation Estimator Tool Open Competitive Job Opportunity Your Specific Responsibilities: Come Join DOH-Team Duval! If you are looking to establish an exciting and successful career in Public Health, you have come to the right place. Many of our innovative and successful health programs are recognized throughout Florida. This position spends the majority of the time engaged in supervisory responsibilities. This includes communicating with, motivating, training, and evaluating employees in addition to planning and directing employees' work. The incumbent has the authority to hire, transfer, suspend, lay off, recall, promote, discharge, assign, reward, or discipline subordinate employees or effectively recommend such action. The incumbent will also be required to develop performance expectations, meet with staff regularly to discuss performance, complete performance reviews, maintain vacation and work schedules, ensuring proper coverage, and complete timesheets. This includes oversite of clinical staff and clinical functions. This supervisory position provides professional nursing services in the care and treatment of patients within the Florida Department of Health in Duval County. The position reports directly to the Assistant Community Health Nursing Director. Public Health Competency Domain 1: Analytical/Assessment skills Public Health Competency Domain 2: Policy development/Program planning skills Public Health Competency Domain 3: Communication skills Public Health Competency Domain 4: Cultural Competency skills Public Health Competency Domain 6: Public Health Sciences skills Accurately applies nursing principles and techniques in the direct care and treatment of women's health, family planning, and/or pediatric patients as well as oversight of the immunization program and staff. Correctly makes assessments of and document's patient health status. Assesses, treats, evaluates, and provides health education and follow up with appropriate cultural competence. Positively assists provider in clinic session. Interprets and implements provider's orders and recommendations to patients appropriately. Completes and follows up on referrals as appropriate and accurately documents all clinically relevant information. Provides exemplary customer service during telephone and walk-in triage as necessary in consultation with the provider. Properly obtains vital signs and medical history; and performs simple laboratory procedures (finger stick, heel stick). Willingly and proactively maintains inventory of medical supplies and medications; and prepares examination/treatment rooms and equipment. Occasional provision of vaccines, FLSHOTS data entry, and inventory maintenance. Public Health Competency Domain 5: Community Dimensions of Practice skills Promotes cooperation within the agency and externally by maintain positive relationships with Management Team, Physicians, Advanced Practice Providers, Nurses, Health Support Technicians, Human Service Counselors, Senior Clerks and other staff. Develops and maintains an interdisciplinary team approach to patient care and case management. Works in collaboration with all partners. Participates in quality improvement activities, including the peer review process. Public Health Competency Domain 8: Leadership and Systems Thinking skills Public Health Competency Domain 7: Management skills Provides oversight of all clinical functions and serves as a resource/expert for nursing functions in assigned clinic. Provides the team with leadership to assure integrated operations with all clinical staff and operating units. Acts as a liaison between administration and the health center staff for the dissemination of nursing policy and practice information. Ensures adherence to nursing protocol policies. Works in collaboration with other administrators to assist in hiring and retaining competent clinical staff. Ensures that the clinical staff is trained, and the orientation checklist is completed within 90 days of hire. Participates in staff development programs for persons assisting with client care. Oversees the work activities of ancillary personnel. Provides assessments and evaluation of clinical staff performance to the Medical Director. Promotes professional leadership and growth. Ensures timely completion of all mandatory training. Ensures accurate and timely submission of Employee Leave and Attendance Records, as well as Employee Activity Records (EARs). Provides services as required during disasters and performs other related duties as required. Travel is performed in relation to above duties. Access to a personal vehicle and a current Florida Driver's License and Nursing License are essential to the performance of the duties described for this position. Performs all other duties as assigned. Incumbent will have access to records containing social security numbers in the performance of job duties. Required Knowledge, Skills, and Abilities: The Registered Nurse Consultant demonstrates the following leadership competencies for the management and supervision of their team: Emotional Presence - maintains appropriate self-confidence and controls emotional reactions when relating to others in a group or one-on-one so effective communication can occur. Communicates without ridicule, threats, or emotional outbursts. Allows time for practice of new tasks or skills. Explains reasoning behind own opinions. Remains calm in high-pressure situations. Demonstrates high standards of ethical conduct. Budget Management- monitors expenditures in support of programs and policies. Identifies cost-effective approaches. Impact and Influence - possesses an intention to persuade, convince, influence, or impress others in support of DOH-Duval vision, mission, and strategy. Promotes professional leadership and growth. Managing Change - motivates, trains, and develops a diverse workforce and provides an environment conducive to achievement and growth. Staffing - assesses current and future staffing needs based on agency goals and budget realities. Ensures staff are appropriately selected, developed, utilized, appraised, and rewarded; takes corrective action appropriately. Interpersonal - establishes productive, cooperative relationships with subordinates, peers and management. Understands and responds to others' needs and priorities. Resolves conflict in positive ways. Works in collaboration with all partners. Judgment - weighs alternative courses of action and makes decisions that reflect factual information and are based on rational and logical assumptions that take organizational resources into consideration. Ensures adherence to protocol, policies, and procedures. * Knowledge of nursing principles, practices and techniques. * Knowledge of human anatomy and physiology. * Ability to administer prescribed medications. * Ability to provide direct patient care and treatment. * Ability to work with patients having a variety of physical problems. * Ability to plan, organize and coordinate work assignments. * Ability to communicate effectively verbally and in writing. * Ability to establish and maintain effective working relationships with others. * Skills in the use of medical equipment and instruments used in providing nursing care. Qualifications: Minimum: * Licensure as a Registered Professional Nurse in accordance with Chapter 464, Florida Statue Florida Department of Health Mission, Vision, and Values: Mission: To protect, promote & improve the health of all people in Florida through integrated state, county & community efforts. Vision: To be the Healthiest State in the Nation. Values: I nnovation: We search for creative solutions and manage resources wisely. C ollaboration: We use teamwork to achieve common goals & solve problems. A ccountability: We perform with integrity & respect. R esponsiveness: We achieve our mission by serving our customers & engaging our partners. E xcellence: We promote quality outcomes through learning & continuous performance improvement. Where You Will Work: Florida Department of Health in Duval County Locations may vary Jacksonville, Florida The Benefits of Working for the State of Florida: Working for the State of Florida is more than a paycheck. The State's total compensation package for employees features a highly competitive set of employee benefits including * Annual and Sick Leave benefits * Nine paid holidays and one Personal Holiday each year * State Group Insurance coverage options, including health, life, dental, vision, and other supplemental insurance options * Retirement plan options, including employer contributions (For more information, please click ************** * Flexible Spending Accounts * Tuition waivers * And more! For a more complete list of benefits, including monthly costs, visit ***************************** Please be advised: Your responses to qualifying questions for this position must be verifiable by documentation provided through the electronic application process. This position requires a security background check and/or drug screening and participation in direct deposit. Any misrepresentations or omissions will disqualify you from employment consideration. Note: You will be required to provide your Social Security Number (SSN) in order to conduct this background check Successful completion of a drug test is a condition of employment for safety-sensitive positions. Male applicants born on or after October 1, 1962, will not be eligible for hire or promotion unless they are registered with the Selective Services System (SSS) before their 26th birthday, or have a Letter of Registration Exemption from the SSS. For more information, please visit the SSS website: ****************** If you are a retiree of the Florida Retirement System (FRS), please check with the FRS on how your current benefits will be affected if you are re-employed with the State of Florida. Your current retirement benefits may be canceled, suspended or deemed ineligible depending upon the date of your retirement. The successful candidate will be required to complete the Form I-9 and that information will be verified using the E-Verify system. E-Verify is operated by the Department of Homeland Security in partnership with the Social Security Administration to verify employment eligibility. Incumbents may be required to perform emergency duty before, during, and/or beyond normal work hours or days. All Florida Department of Health positions require the incumbent to be able to learn and communicate effectively, orally and in writing, in English. Applicants who do not meet this requirement will not be considered. The State of Florida is an Equal Opportunity Employer/Affirmative Action Employer and does not tolerate discrimination or violence in the workplace. Applicants requiring a reasonable accommodation, as defined by the Americans with Disabilities Act, must notify the agency hiring authority and/or People First Service Center (***************. Notification to the hiring authority must be made in advance to allow sufficient time to provide the accommodation. The State of Florida supports a Drug-Free workplace. All employees are subject to reasonable suspicion drug testing in accordance with Section 112.0455, F.S., Drug-Free Workplace Act. Florida has the third largest population of veterans in the nation with more than 1.5 million service men and women. The Florida Department of Health (department) is committed to serving members of the United States Armed Forces, veterans and their families by encouraging them to apply for vacancies that fit their area of knowledge and/or expertise. Through the Department's VALOR program, which expedites licensing for military veterans, the Department also waives initial licensing and application fees for military veterans who apply for a health care professional license within 60 months of an honorable discharge. These initiatives help ensure that the transition from military service into the workforce is as smooth as possible and reflects our appreciation for the dedication devoted to protecting our country. The State of Florida is an Equal Opportunity Employer/Affirmative Action Employer, and does not tolerate discrimination or violence in the workplace. Candidates requiring a reasonable accommodation, as defined by the Americans with Disabilities Act, must notify the agency hiring authority and/or People First Service Center (***************. Notification to the hiring authority must be made in advance to allow sufficient time to provide the accommodation. The State of Florida supports a Drug-Free workplace. All employees are subject to reasonable suspicion drug testing in accordance with Section 112.0455, F.S., Drug-Free Workplace Act. VETERANS' PREFERENCE. Pursuant to Chapter 295, Florida Statutes, candidates eligible for Veterans' Preference will receive preference in employment for Career Service vacancies and are encouraged to apply. Certain service members may be eligible to receive waivers for postsecondary educational requirements. Candidates claiming Veterans' Preference must attach supporting documentation with each submission that includes character of service (for example, DD Form 214 Member Copy #4) along with any other documentation as required by Rule 55A-7, Florida Administrative Code. Veterans' Preference documentation requirements are available by clicking here. All documentation is due by the close of the vacancy announcement. Location:
    $75.1k-83k yearly 11d ago
  • Trailer Utilization Coordinator

    Landstar 4.4company rating

    Utilization review nurse job in Jacksonville, FL

    Schedule: Monday - Friday, 8am-5pm Salary: $18.28 - $ 22.86/hour based one experience What work will you perform? As part of the Trailer Utilization Department, you will provide key assistance in maximizing the revenue and utilization of Landstar's trailer fleet through the research and reallocation of trailer equipment within the network. Your ability to maintain focus in a fast-paced environment with strong time management capabilities including the capacity to prioritize tasks effectively will help you be successful with trailer placement and planning for other daily tasks. Your previous communication experience will assist you in resolving concerns with customers and collaborating with team members. Essential Responsibilities: Research historical data related to company-controlled assets using multiple systems of record Assist internal and external customers via inbound and outbound phone calls and emails to coordinate trailer placement with Landstar agents and drivers Identify opportunities through research to reposition company assets that are deemed to be underperforming Dispatching and processing payments to reposition company assets Satisfy internal and external customer requests for assets promptly Required Minimum Experience and Qualifications: High school diploma or general education degree (GED) 6 months of customer service experience Preferred Experience and Qualifications: 6 months of call center experience 6 months of transportation/logistics experience Knowledge, Skills, and Abilities: Ability to work in a fast-paced environment Microsoft Office and Internet knowledge Strong oral and written communication skills Professional demeanor Good organizational skills Extensive time management capability Self-motivated with ability to collaborate in a Team setting Critical thinking; ample ability to utilize resources for decision making purposes
    $18.3-22.9 hourly 3d ago
  • Nurse Case Manager

    Actalent

    Utilization review nurse job in Jacksonville, FL

    The OB RN Case Manager will coordinate care for maternal and child health populations, ensuring safe, evidence-based interventions across the continuum of care. This role is integral in conducting intake assessments, creating individualized care plans, coordinating discharges, and continuously monitoring clinical outcomes to support compliance with Medicaid contracts and promote improved maternal and neonatal outcomes. Responsibilities * Conduct intake assessments for maternal and child health populations. * Develop individualized care plans based on evidence-based interventions. * Coordinate discharge planning and ensure seamless transitions of care. * Monitor clinical outcomes and maintain high-quality standards. * Manage a high-volume caseload effectively and efficiently. * Ensure compliance with Medicaid contracts. * Provide support for improved maternal and neonatal outcomes. * Document all case management activities accurately using EHR systems. Essential Skills * Active RN license in Florida. * 3-5 years of clinical experience in obstetrics, high-risk antepartum, or NICU. * 3-5 years of experience in case management within a managed care organization, health plan, or insurance carrier. * Experience with utilization management. * Strong organizational and documentation skills. * Proficiency in care coordination and discharge planning. * Ability to work independently and meet productivity metrics. Additional Skills & Qualifications * Bachelor's Degree in Nursing (Master's preferred). * Strong communication and interpersonal skills. * Ability to work collaboratively in a multidisciplinary team. * Proficiency with Microsoft Office and EHR platforms. * Flexibility to adapt to changing priorities and hybrid schedules. * InterQual experience. * Certified Case Manager. * Familiarity with Medicaid/Medicare regulations. * Experience with motivational interviewing. * Understanding of maternal health quality measures (HEDIS). * Experience in managed care or health plan settings. * Cultural competence and patient engagement skills. * Familiarity with community resources such as Healthy Start, WIC, and SNAP. Work Environment This position is based in a remote work environment in Florida. The schedule is Monday through Friday, from 8:30 AM to 5:00 PM with a 30-minute lunch break. There is flexibility in start times. Must be ok going on-site 2 times a year for meetings (will be paid). The role offers a supportive environment that emphasizes professional growth, collaboration, and the chance to make a meaningful impact on community health. Job Type & Location This is a Contract to Hire position based out of Jacksonville, FL. Pay and Benefits The pay range for this position is $38.00 - $43.00/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: • Medical, dental & vision • Critical Illness, Accident, and Hospital • 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available • Life Insurance (Voluntary Life & AD&D for the employee and dependents) • Short and long-term disability • Health Spending Account (HSA) • Transportation benefits • Employee Assistance Program • Time Off/Leave (PTO, Vacation or Sick Leave) Workplace Type This is a hybrid position in Jacksonville,FL. Application Deadline This position is anticipated to close on Jan 19, 2026. About Actalent Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500. The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.
    $38-43 hourly 13d ago
  • Field Nurse Case Manager (1099) - Jacksonville, FL

    The Ima Group 4.4company rating

    Utilization review nurse job in Jacksonville, FL

    Description Now Hiring: Field Case Managers (RN) - Jacksonville, FL (1099) The IMA Group is actively expanding across Florida and seeking experienced Field Case Managers to join our growing 1099 network. We offer flexible, independent contractor opportunities for RNs with at least one year of workers' compensation experience. Whether you're looking to manage a few cases or maintain a full caseload, we allow you to build a schedule that fits your availability. As a Field Case Manager, you'll oversee the medical treatment of individuals with workplace injuries, collaborating with insurance carriers, medical providers, attorneys, employers, and injured workers. Your role is critical in ensuring timely and appropriate medical care, while helping achieve return-to-work goals in a cost-effective manner. Responsibilities: Provide comprehensive medical case management in coordination with patients, physicians, healthcare providers, employers, and referral sources. Evaluate treatment plans for appropriateness, medical necessity, and cost-efficiency. Coordinate Independent Medical Evaluations (IMEs) and/or perform job site evaluations. Track patient progress, engage with providers, and offer medical recommendations to all stakeholders. Prioritize casework effectively and develop strategic plans for care management. Prepare timely, detailed reports and attend medical appointments as required. Qualifications: Current license as an RN. Minimum of 3 years of workers' compensation case management experience. Malpractice Liability Insurance (or willingness to obtain). Strong computer/technology proficiency. Bilingual skills preferred. Access to a personal computer, phone, and reliable transportation for in-person appointments. The IMA Group is an Affirmative Action/Equal Opportunity Employer Our Government Services Division supports local, state, and federal agencies and delivers professional and objective medical and psychological examinations as well as ancillary services. Our Payer Services Division meets the evaluation and screening needs of Carriers, TPAs, Public Entities and Employers and includes behavioral health and physical medicine specialty services, working with a wide range of organizations within the workers' compensation, disability, liability, and auto markets. Our Clinical Research Division performs all types of Phase II-IV clinical trials in multiple therapeutic areas through a flexible nationwide network of site locations and virtual capabilities. #LI-BC1 #LI-HYBRID
    $52k-64k yearly est. Auto-Apply 1d ago
  • Dosing Nurse

    New Season 4.3company rating

    Utilization review nurse job in Jacksonville, FL

    Looking for a new opportunity? New Season offers exciting benefits! Take a look at this opportunity to join us in making a powerful impact in your local community! * Full benefits available on DAY ONE * Start accruing up to 3 weeks of PTO starting on DAY ONE * Tuition reimbursement opportunities are available * Up to $2,000 in employee referral bonuses available Ready to get started? Here's what we're looking for in our newest team member! In this role, you will have the opportunity to work under the direction and supervision of our Medical Director, Registered Nurse, and Program Director in a collaborative effort to ensure we are providing the best care and support to our patients in this clinic. You'll have a wonderful opportunity to engage directly with patients and provide them with stellar service as they are going through some of the most difficult times in their lives! For over 30 years, New Season Treatment Centers has been a leading national health care service provider of outpatient treatment centers that specialize in providing safe, quality, and best-in-class care for individuals living with Opioid Use Disorder ("OUD"). Curious what your day-to-day may look like and how you'll be making a big positive impact on your local community? Essential Functions: * Supply and administer medication pursuant to the physician's order and record dosage administered in the medical record. * Conduct an actual sight and count inventory of the medication supply daily. * Maintain absolute accuracy in the daily accounting of medication that is supplied or administered in inventory. * Collect fees and perform daily cash reconciliation in the absence of a cashier position. * Ensure the disposal of medical waste through the proper protocol. * Observe the patient's demeanor prior to dosing. * Contact other centers to verify dosages as needed. * Administer appropriate lab tests as required, including patient vital signs, TB tests when required, and collect data for review by the Medical Director or RN. * Schedule and screen patients to be seen by the Medical Director. * Assist the Medical Director in collecting data for the history and physical as required. * Maintain absolute control, tracking, and confidentiality of all patient medical paperwork. * Actively participate in CARF preparation and the state audit process. * Interface with the public and patients by answering phones, greeting visitors, and monitoring patient activities while on center's premises. Benefits: * Early morning hours (Allows for a great work-life balance) * Competitive Pay * Generous PTO (3 weeks with buy-up options) * Excellent Medical (EPO & PPO plans), Dental, and Vision Insurance * Life Insurance * Short/Long Term Disability * 401k with up to 3% matching * Reimbursement for education, license, tuition, etc. * Referral bonus (up to $2,000) Essential Qualifications: * Education/Licensure/Certification: Active LPN license in your state. * Required Knowledge: Understanding of opiate addiction, medical terminology, general nursing knowledge, and techniques. Basic mathematics skills. Must be computer literate and have basic knowledge of all Microsoft products, including Word, Outlook, and Excel. Must have basic typing skills. * Experience Required: Minimum of 1 year of direct patient contact. Prior experience in the clinical environment is helpful. New Season provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. Job or State Requirements LPN in FL or multistate
    $45k-55k yearly est. 59d ago
  • Np - 15501642

    Baptist Primary Care Lane Avenue

    Utilization review nurse job in Jacksonville, FL

    Baptist Primary Care Tapestry Park is seeking a Full-time Nurse Practitioner. The provider must be comfortable with Women's and Men's Health, pediatric care, acute patients, chronic patients, physician-patient follow-ups, hospital follow-ups & wellness exams. Proficiency with EMR required. Excellent oral and written communication skills. What You Can Expect • Compensation starting at $115k • 15-17 patients per day • No call schedule • 40 patient-facing hours a week • Epic EHR System All About the Benefits • Collaborative work environment • Continue professional growth through CME Education Required Master's Degree - Nursing Education Preferred Master's Degree - Nursing Experience • 1-2 years Family Practice Experience License and Certification • Certified Nurse Practitioner Required • Licensed Advanced Registered Nurse Practitioner Required
    $115k yearly 60d+ ago
  • Nursing QMA

    Sonida Senior Living 4.4company rating

    Utilization review nurse job in Saint Augustine, FL

    Find your joy here, at The Addison of St. Johns, a Sonida Senior Living community! We offer a comprehensive benefit package to include competitive wage/salary, health and dental insurance, 401k with company match & much more! The Addison of St. Johns, a premier retirement community in St. Augustine, FL, provides quality care to residents in an assisted living and memory care community. What we offer you: Flexible scheduling** Cutting edge technology to enhance the lives of our residents and make your job easier and more effective. SafelyYou - AI video technology that detects and prevent falls Advanced EHR Technologies - automated care assessments eliminating busy work, helping you deliver better care Sage - Improve call light response time and improvement to service and care Microsoft Power BI - one stop for all data needs Company support for educational and learning opportunities Paid referral programs for Team Member and Resident referrals Medical, dental, vision, and life/disability insurances* 401k retirement savings offering a discretionary match determined each year based on company performance Employee Assistance Program Dependent Care and FSA saving accounts PTO available day one Paid Training *Benefit eligibility dependent on employment status **Eligibility based on location Medication Aide Responsibilities include: You will be responsible for setting up and administering resident medications as ordered by physicians and per professional standards of medication administration, and may supervise CNAs as directed Provides patients' personal hygiene by giving bedpans, urinals, baths, backrubs, shampoos, and shaves; assisting with travel to the bathroom; helping with showers and baths Provides for activities of daily living by assisting with serving meals, feeding patients as necessary; ambulating, turning, and positioning patients; providing fresh water and nourishment between meals Maintains patient stability by checking vital signs and weight; testing urine; recording intake and output information Qualifications: [Must be licensed in [STATE] as a [Medication Aide], and must maintain current and unencumbered licensure]
    $32k-50k yearly est. 60d+ ago
  • Dialysis Nurse (Dialysis Experience Required)

    Davita 4.6company rating

    Utilization review nurse job in Palm Coast, FL

    Posting Date 11/10/202513 KINGSWOOD DRSTE A, PALM COAST, Florida, 32137-4614, United States of America DaVita is seeking a Nurse who is looking to give life in an outpatient dialysis center. You can make an exceptional difference in the lives of our patients and their families dealing with end-stage renal failure or chronic kidney disease. Do you desire to deliver care in an empathetic, compassionate way - the way you'd want your own care to be? If you haven't considered Nephrology before, read on as we think that you should. DaVita - which is Italian for "giving life" - is working to provide quality service to patients, partners, and teammates. Our mission is to be the Provider, Partner, and Employer of Choice. Some details about this position: Dialysis experience is required. Training may take place in a facility or a training clinic other than your assigned home clinic Float to various clinics during and after your training You must have a flexible schedule and be able to work mornings, evenings, weekends, and holiday What you can expect: Build meaningful and long term relationships with patients and their family in an intimate outpatient setting. Be a part of a team that supports and relies on each other in a positive environment. Deliver care to patients who are often dealing with multiple co-morbidities which require unique treatment plans and the ability to leverage a broad range of nursing skills and knowledge. Oversee a group of patients with the support of PCTs to conduct patient observations, measuring stats and machine set up. You will work with your head, heart and hands each day in a fast paced environment. What we'll provide: DaVita Rewards package connects teammates to what matters most including: Comprehensive benefits: Medical, dental, vision, 401(k) match, paid time off, PTO cash out Support for you and your family: family resources, EAP counseling sessions, access Headspace , backup child and elder care, maternity/paternity leave, pet insurance, and more Paid training Requirements: Associates Degree in Nursing (A.D.N) from accredited school of nursing required; Bachelor of Science in Nursing (B.S.N); three-year diploma from accredited diploma program may be substituted for nursing degree You might also have experience in the following that can be helpful but not required Intensive Care Unit (ICU), Critical Care Unit (CCU), Emergency Room (ER), or Medical Surgical (Med Surg) experience Certified Nephrology Nurse (CNN) or Certified Dialysis Nurse (CDN) DaVita is a clinical leader! We have the highest percentage of facilities meeting or exceeding CMS's standards in the government's two key performance programs. We expect our nurses to commit to improving patient health through clinical goal setting and quality improvement initiatives. Ready to make a difference in the lives of patients? Take the first step and apply now. #LI-TM3 At DaVita, we strive to be a community first and a company second. We want all teammates to experience DaVita as "a place where I belong." Our goal is to embed belonging into everything we do in our Village, so that it becomes part of who we are. We are proud to be an equal opportunity workplace and comply with state and federal affirmative action requirements. Individuals are recruited, hired, assigned and promoted without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, protected veteran status, or any other protected characteristic. This position will be open for a minimum of three days. For location-specific minimum wage details, see the following link: DaVita.jobs/WageRates Compensation for the role will depend on a number of factors, including a candidate's qualifications, skills, competencies and experience. DaVita offers a competitive total rewards package, which includes a 401k match, healthcare coverage and a broad range of other benefits. Learn more at *********************************** Colorado Residents: Please do not respond to any questions in this initial application that may seek age-identifying information such as age, date of birth, or dates of school attendance or graduation. You may also redact this information from any materials you submit during the application process. You will not be penalized for redacting or removing this information.
    $49k-72k yearly est. Auto-Apply 60d+ ago
  • Nurse Assessments - WEEKLY PAY!

    Concierge Care Agency 3.4company rating

    Utilization review nurse job in Jacksonville, FL

    Job Description Nurse Needed for Assessments - Jacksonville, FL | Flexible Schedule | Weekly Pay Concierge Care is actively seeking a Registered Nurse (RN) to perform home care assessments for clients in the Jacksonville area. This is a W-2 position offering flexible hours and weekly pay, ideal for nurses looking to pick up extra hours without committing to a full shift schedule. Position Highlights: Role: In-home assessments and care plan updates Location: Jacksonville, FL + surrounding areas Schedule: PRN / As needed Compensation: Weekly direct deposit Employment Type: W-2 employee Start Date: ASAP Ideal Candidate Will Have: Active Florida RN CPR certification Strong assessment and documentation skills Reliable transportation and professional demeanor Prior home care or senior care experience preferred Responsibilities Include: Completing initial in-home assessments and recertifications Updating client care plans and reporting findings Communicating with office staff regarding client status or needs Ensuring documentation is accurate and timely If you're looking to supplement your schedule and work independently while making an impact, apply today! Cases are available immediately, and we will match you with locations near you. At Concierge Care we believe in the mission of home health care. If competitive pay, schedule flexibility, and professional growth are what you are looking for, apply today! Please do not apply if you do not authorize us to conduct a comprehensive review of your background for contracting purposes. By applying you understand that the scope of the report may include civil and criminal history records from any criminal justice agency in any or all federal, state, county jurisdictions; driving records, birth records, and any other public records. We are an equal opportunity employer and prohibit discrimination/harassment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
    $50k-61k yearly est. 5d ago
  • Nurse Scientist

    Mayo Clinic 4.8company rating

    Utilization review nurse job in Jacksonville, FL

    Mayo Clinic nurse scientists conduct clinically based research to improve the health and well-being of patients and their caregivers across the life span. At Mayo Clinic, you will be part of an amazing team committed to solving the most serious and complex health care challenges - one patient at a time. To learn more visit: Overview - Mayo Clinic Research. Nurse scientists engage with Mayo Clinic physicians and scientists from a variety of disciplines as well as with those external to Mayo Clinic to generate knowledge in fields that span the continuum of care. Mayo Clinic nurse scientists focus on generating symptom science, self-management science, and caregiving science to improve the health of patients with complex conditions. Mayo Clinic nurse scientists are expected to develop and sustain a focused program of research supported by competitive extramural federal/foundation funding sources as well as competitive intramural funding with evidence of a robust publication record in leading peer-reviewed journals in the field. With an 83,000-person workforce, Mayo Clinic cares for more than 1.4 million people each year with serious or complex illnesses from all 50 U.S. states and 135 countries. Mayo Clinic is the largest not-for-profit, multidisciplinary academic medical center in the world with over 4,000 physicians and scientists in an integrated multi-campus system spanning the globe. The unified mission at Mayo Clinic is to provide the best patient care, backed by our expertise and supported by innovation in education, research and practice, to bring hope and healing in times of need. We embrace collegial relationships among campuses (Arizona, Florida, Rochester, and the Midwest Mayo Clinic Health System) allowing for best practices and innovation to help solve the most serious complex medical challenges-one patient at a time. We support a vibrant and diverse research enterprise, with programs in basic, translational, clinical, population, and data sciences. In 2024, the institution received over $754 million in extramural research awards, supplemented with over $517 million of institutional support. Laboratories and shared resource facilities are state-of-the-art, including those for biomolecular analysis, molecular development, data analytics, specimen processing, and structural testing and imaging. Mayo Clinic supports innovation and has a wealth of resources available - including an integrated health record and collaboration with top specialists. Jacksonville is the largest city in area in the continental United States - a beautiful coastal Florida city that features excellent year-round climate, over 20 miles of beaches and outstanding outdoor recreational, cultural and family-oriented amenities. The “River City by the Sea” has an excellent school system, reasonable cost of living and a thriving business environment. Medical professionals and patients are drawn to Jacksonville by an extraordinary network of high-profile healthcare facilities. Jacksonville continues to grow as more people relocate from all over the U.S. and abroad, to see what the great River City has to offer! Qualifications Qualifications: Candidates must have a PhD, be licensed/eligible to be licensed as a registered nurse in Florida and have completed post-doctoral fellowship training if early career. Mid- and senior career candidates without formal post-doctoral training will be considered on an individual basis. Candidates must also have a track record of scholarly productivity and extramural funding or a strong potential for extramural funding. Applications: Applications should include a CV with Bibliography, Cover Letter, Statement of Research Interests, and contact information of three professional references. For more information contact: Linda L. Chlan, Ph.D., R.N., ATSF, FAAN Associate Dean for Nursing Research c/o: *************************
    $52k-69k yearly est. Auto-Apply 60d+ ago
  • HEDIS Nurse

    Integrated Resources 4.5company rating

    Utilization review nurse job in Jacksonville, FL

    I ntegrated Resources, Inc., is led by a seasoned team with combined decades in the industry. We deliver strategic workforce solutions that help you manage your talent and business more efficiently and effectively. Since launching in 1996, IRI has attracted, assembled and retained key employees who are experts in their fields. This has helped us expand into new sectors and steadily grow. Job Description Clinical Nursing staff must have an active Florida license. Recent experience in data collection for HEDIS / Stars preferred. Determine member compliance according to the NCQA technical specifications. Computer skills are critical. Excellent verbal and phone skills are required. Communicate with provider, internal customers and external vendors. Organizational skills are very important ; must be able to work independently to complete tasks with minimal direction. Position will include some administrative tasks to including but not limited to; faxing, and populating spreadsheets. Required to track, monitor and report on the status of records and volume of work. Requirements: Active Florida Nursing License Previous medical record review experience; HEDIS preferred Medical Review Nurses: Quality review / disease management experience AAAHC, Joint Commission, or Magnet experience is helpful Proficient in Microsoft Word and Excel Excellent communication skills Successful completion of Excel test Additional Information All your information will be kept confidential according to EEO guidelines.
    $47k-69k yearly est. 1d ago
  • Summer Camp Nurse (Youth Camp)

    Florida Sheriffs Youth Ranches 3.8company rating

    Utilization review nurse job in Pierson, FL

    Job DescriptionWe need motivated people with a passion for working with youth. SUMMARY The Nurse coordinates medical services for youth in care at the Camp and is responsible for maintaining appropriate records and files pertaining to medical services. The Nurse is directly responsible to the Camp Director. This temporary position for the summer camp season and is not eligible for overtime. ESSENTIAL DUTIES AND RESPONSIBILITES The following duties and responsibilities are given as examples of the various types of work performed in this position. Other duties and responsibilities may be assigned. Portrays compassion and hospitality when providing medical care to the youth in program. Completes youth assessments on an initial and ongoing basis, including physical, dental, vision, hearing and other areas as appropriate. Assists the Camp Director in the initial review of camper applications to determine appropriateness for the camp program based on medical issues. Uses thoroughness and discretion while dispensing medications and maintaining accurate medical files for participants of programs. Practices alertness and truthfulness in keeping the Camp Director informed of medical concerns, safety issues, and incident follow-up. Exhibits enthusiasm and persuasiveness during leadership of medical and safety related trainings for staff. Demonstrates resourcefulness and thriftiness in the wise stewardship of the agency's resources when ordering and maintaining medical supplies for all of Camp. Ensures the orderliness of supplies and equipment are adequate and inventoried regularly. Expresses gentleness and attentiveness when arranging for the medical care of youth in program including regularly scheduled or emergency services. Maintains good public relations with the medical community as a liaison between Youth Ranches and doctors, emergency rooms, pharmacies and other medical providers. Prepares medical standing orders and has local doctor approve and sign camps medical procedures and standing orders annually prior to summer camp. Displays dependability and flexibility when assisting other staff members with tasks as needed or approved by Camp Director. EDUCATION AND EXPERIENCE REQUIREMENTS The person filling this position must be a graduate of an accredited nursing program and currently licensed as a Nurse with the State of Florida (requires licensure as a Registered Nurse.) Previous experience in the nursing field, particularly dealing with youth is preferred. Salary - $22.00 an Hour We are an equal opportunity employer and a drug free workplace. We have a very extensive and strict background screening process. Background Screening Requirement Employment in this position is contingent upon successful completion of a Level 2 background screening through the Florida Department of Law Enforcement (FDLE) Care Provider Background Screening Clearinghouse, as required by Florida law. Pursuant to House Bill 531 (2025), applicants are encouraged to review the Care Provider Background Screening Clearinghouse Education and Awareness information available at: ******************************** Powered by JazzHR 934x2pS77n
    $22 hourly 3d ago
  • Wellness Nurse (PRN)

    Experience Senior Living

    Utilization review nurse job in Palm Coast, FL

    The Experience Senior Living Team is comprised of dynamic professionals that are fueled by their passion to empower people as they grow older to live life to the fullest. They are creators, architects, nurses, researchers, programmers, marketers, facilitators, developers, investors, and caregivers, all focused on making a positive impact on the lives of residents, their families and team members. We are looking for a Wellness Nurse to join our amazing team! Responsibilities: Servant Leadership directs all aspects of decision making Serve as the “Charge Nurse” in the absence of the Executive Director and Director of Health & Wellness Contributes to all aspects of medication management, including but not limited to; orders, administration, storage, documentation and as mandated by the State Regulations and Guidelines as well as Company policy and procedure Assures resident rooms and common areas are always clean and safe Assure that all care partners and medication assistants are familiar with the residents' individual conditions and are trained to provide the resident services in an effective, professional, and sensitive manner Assist the residents with their self-medication or administration of medications Responsible for limited nursing license daily recommendations and documentation (if applicable) Implements plans of care recommended by the Resident Wellness Director Implements change in condition plans Provides accurate and timely documentation of all care provided to residents Complete resident charting in the electronic health record and assists in completion of assessments as scheduled or with change in condition Completes accident and incident reports as required Maintains positive relationships with residents, family members and responsible parties Be prepared for and manage emergency situations including disasters, fire, and other emergencies Ensures adequate and appropriately trained care partners and medication assistants are available for each shift as scheduled, within company and state guidelines Requirements Licensed Vocational Nurse/Licensed Practical Nurse or Registered Nurse license(LVN/LPN preferred) Two (2) years' experience in a senior living environment preferred Basic First Aid and CPR certification Must successfully complete all company specified training programs Effective communication skills commensurate with professional standards. Strong organizational skills. Ability to communicate effectively with wellness team members, leadership team, residents, family members, vendor partners, referral sources and outside contacts Appearance is neat, clean, and according to dress code. Ensure team members in the department adhere to dress code standards and safety. Able to demonstrate a high level of service delivery; does what is necessary to ensure customer satisfaction; deals with service failures and prioritizes customer needs. Able to make independent decisions Able to clearly present information through the spoken word; reads and interprets complex information; talks with residents, family members and customers; listens well. Able to communicate with others in a warm and helpful manner while simultaneously building credibility and rapport. Able to work cooperatively with a group of people to achieve goals and objectives. Able to be tactful; maintains confidences, and fosters an ethical work environment; prevents inappropriate behavior by coworkers; gives proper credit to others, handles all situations honestly. Able to keep an open mind and change opinions based on new information: performs a variety tasks and changes focus quickly as demands change; manages transitions effectively from task to task; adapts to varying customer needs. Ability to work varied schedules to include weekends, evenings, and holidays. Benefits We offer a full benefits package that includes medical, dental, vision, STD/LTD, life and voluntary life, 401k with employer matching, paid holidays, and up to 20 days PTO in the first three years. Background Screening Requirement Employment is contingent upon successful completion of background screening in accordance with Florida law and company policy. Certain positions may require fingerprinting and Level 1 or Level 2 background screening. Applicants can review Florida care provider background screening requirements here: ********************************
    $38k-63k yearly est. Auto-Apply 60d+ ago
  • Staff Nurse

    QSL Management

    Utilization review nurse job in Saint Augustine, FL

    Full-time Description QSL Management is a fast-growing senior living company with ample opportunities for advancement. Our mission is to provide seniors with luxurious and comfortable resort-style homes while promoting wellness, security, longevity, family, joy, and self-worth. We believe in fostering an environment in which our team members can grow and thrive, and we are looking for leaders who exemplify our core values of Excellence, Compassion, Respect, Leadership, Integrity, Safety, & Joy. We are looking for team members who want to serve others. We offer a competitive wage and an excellent benefits package. Plus, we have a great work environment where you can make a difference in the lives of older adults. If this sounds like the opportunity that you have been looking for, please apply. We are currently looking for a Staff Nurse for The Blake at St Johns Primary Responsibilities of the Staff Nurse: Provide medical treatment and administer medication according to physician orders within the scope of their applicable board and state regulations for assistant living. Provide world class care and service for our residents while remaining flexible and adapt to change. Assist residents with memory and performance improvement programs. Work independently (with minimal direct supervision) and with a team to make decisions, organize/prioritize tasks effectively, document clearly, and follow through on assignments. Serve as charge nurse on shift for the personal assistants under the direction of the Wellness Leadership team Requirements Must have a caring heart, willing to serve others. Current license for Licensed Practical Nurse (LPN) issued by the state. Current CPR certification Assisted Living or Long-term care experience preferred Current First Aid certification preferred Must be flexible and prepared to work a variety of shifts including weekends and holidays 7am to 7pm Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities Salary Description $27.00 to $30.00 an hour depending on experience
    $27-30 hourly 60d+ ago
  • Theranostic Nurse - $2,000 Sign-On Bonus

    Cancer Specialists LLC 4.3company rating

    Utilization review nurse job in Jacksonville, FL

    Why Cancer Specialists of North Florida (CSNF) CSNF is the largest physician owned private practice oncology group in Jacksonville. Our employees demonstrate their expertise by providing exceptional patient care while maintaining a work life balance. NO WEEKEND OR HOLIDAY HOURS . CSNF is currently recruiting a Theranostic Nurse for our busy Specialty Practice offering a GENEROUS SIGN-ON BONUS . The Imaging Theranostic nurse works within the imaging department to facilitate the radioligand therapeutic treatment plan for CSNF patients and assisting imaging patients under the guidance of the Imaging Manager/Theranostics Lead Technologist, and Radiation Oncologist/Authorized User. Essential duties and responsibilities include the following: Prepares patient and explains theranostic procedure Monitor vital signs and assesses signs and symptoms according to theranostic protocol Assists with delivering theranostic agent to patient according to protocol/procedure Educating patients and/or family members Performs patient assessments Starts and maintains intravenous access for imaging/therapy patients Port Access for all imaging/therapy patients Assisting therapy patients with additional medications on same day of treatment Communicates with Imaging Manager, Staff, and patient care team Familiar with radiation safety and protection, ALARA principals Hippa Compliance Updating EMR Strong clinical judgement Assess patient condition throughout therapy and updates radiation oncologist on changes in patients' condition Acts as an interdepartmental liaison between imaging and radiation departments Facilitates and responds to emergency situations Assists with patient management and the coordination of patient care Ensures patients increase oral fluid intake and advises patients to void as often as possible to reduce bladder radiation Aware of short term and long term side effects of radioligand therapeutic agents Familiar with treatment cycles and reason for delays Maintains and supervises infusion pumps All other duties as assigned Full-time Position, Monday - Friday Education and Experience: Phlebotomy Radiology experience (preferred) 1 year of experience (preferred) Certificates, Licenses, Registrations: Bachelors in Skilled Nursing (BSN) State of Florida Nursing License Certified Radiology Nurse (CRN) designation preferred Compensation and Benefits: Salary is commensurate with experience and qualifications Cancer Specialists of North Florida is an "EEO Employer” and “Drug Free Workplace”
    $56k-68k yearly est. Auto-Apply 4d ago
  • IV Infusion Nurse

    Restore Hyper Wellness Jacksonville Beach

    Utilization review nurse job in Jacksonville Beach, FL

    Job DescriptionBenefits: Employee discounts Training & development Wellness resources Bonus based on performance IV Infusion Nurse (part-time) Restore Hyper Wellness Do you have a passion for nursing but are tired of the hectic, high-stress environment of a clinic or ER? This is your chance to take your career in an exciting, new direction. Restore is seeking an outgoing, experienced Registered Nurse to join our team of wellness professionals on a mission to help people feel better so they can do more of what they love. Were the antithesis of a traditional medical office or clinic, offering innovative wellness services in a fun, comfortable environment. Our nurses have described working for Restore as the most fun you can have at a nursing job while still helping people in a meaningful way. This is your opportunity to take an active role in assisting individuals on their health and wellness journey. Medical Operations & Clinical Duties Administer IV Drip Therapy and Intramuscular (IM) Shots to deliver our menu of vitamins, minerals, and antioxidants. Educate clients on the qualities and benefits of our IV Drip and Intramuscular (IM) Shot ingredients. Administer Hyperbaric Oxygen Therapy sessions. Utilize blood test offerings to help clients optimize their wellness. Promote memberships and medical services based on client needs. Document client visits via electronic medical records. Address and answer client questions using the Restore Nursing Reference Guide under the supervision of the Medical Director and network of licensed Advanced Practice Providers. Communicate to the medical compliance team any issues or adverse effects clients experience. Provide therapeutic communication along with exceptional customer service Assist staff with store services. Assist with off-site nursing events and special projects. This position reports to the Lead Nurse. Maintain a safe and clean working environment. 25% travel required Qualities You Need to Succeed as a Restore Nurse Youre a licensed Registered Nurse (RN). You have at least two years of experience as a nurse in an acute care setting (ER, ICU, Med-Surg or similar). You are BLS (Basic Life Support) certified You have at least one year of experience administering injections. Youre comfortable using electronic medical records to document client details. You maintain a non-judgemental outlook and have a demonstrated ability to work with a diverse clientele. Your verbal and written communication skills are on point. You value ethics and integrity. You embrace a team environment and also excel at working independently. Youre willing to adhere to all policies and procedures and understand the importance of maintaining medical compliance. Benefits of Joining Restore A competitive salary plus monthly bonuses Paid vacation time (for full-time position) Complimentary and discounted access to Restores innovative wellness services Now, a Little About Us Restore Hyper Wellness is the leading retail provider of alternative health and wellness modalities in the United States. Our goal is to make Hyper Wellness widely accessible, affordable, and fun. This means helping people from all walks of life feel better and perform at a higher level so they can do more of what they love in life. Inc. 5000 ranked Restore as the #113 Fastest Growing Company in America, the #17 Fastest Growing Company in Texas, and the #1 Hottest Franchise in America.
    $38k-63k yearly est. 24d ago

Learn more about utilization review nurse jobs

How much does a utilization review nurse earn in Saint Augustine, FL?

The average utilization review nurse in Saint Augustine, FL earns between $43,000 and $76,000 annually. This compares to the national average utilization review nurse range of $47,000 to $89,000.

Average utilization review nurse salary in Saint Augustine, FL

$57,000
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