Utilization review nurse jobs in Tamarac, 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

Under general supervision performs work of routine difficulty in assisting the public in applying for Zoning applications of all types, issuance of Zoning permits, sufficiency review of site plans, processing of public hearing applications and administrative requests. Ensures all applications are in compliance with the City's Land Development Regulations. Contributes to the overall physical development and growth of the City in a manner that enhances quality of life for residents and visitors alike as part of the Planning and Zoning Team. The position requires strong organizational skills, along with diplomacy and professionalism in working effectively with public officials, City personnel, and the general public. This is not intended as a comprehensive list; it is intended to provide a representative summary of the major duties and responsibilities. Incumbent(s) may be required to perform all duties listed, and may be required to perform additional, position-specific tasks. Builds and maintains positive working relationships with co-workers, other employees, and the public using principles of good customer service. Promotes and represents the City to the public in a friendly, helpful, and professional manner. Provides information via telephone, email and in direct contact with the public. Assists customers with inquiries in a prompt, friendly and reliable manner. Responds to zoning related questions in a courteous manner and explains application procedures to the public. Explains Land Development Regulations and plan compliance requirements to developers, architects, engineers, contractors and property owners. Interprets zoning codes, regulations and maps as required, for specific parcels. Articulates technical information to the public related to permitted uses and development standards. Issues forms and assists the public with the City's Planning and Zoning application procedures. Serves as liaison between applicants and the City's e-permitting software (Energov). Prepares e-permit files for review and submittal. Confirms contractor registrations, property ownership, corporate and fictitious name status, State/County licensure and registrations as necessary. Verifies workers compensation and liability insurance as required. Determines compliance with appropriate Zoning codes and ordinances. Monitors all incoming e-permit documents for completeness, accuracy and response dates. Creates invoices and assists in the billing and payment tracking of all e-permit applications. Ensures that all available e-permits are in the appropriate status and step in the approval process. Assures that departmental policies and procedures are followed in the receipt, routing and processing of e-permit applications. Organizes e-permits based on plan review approval or failure. Performs basic zoning reviews with general knowledge of the City's Land Development Regulations. Examines site plans, blueprints, surveys, and specifications for both residential and commercial developments to ensure compliance with application submittal requirements. Distributes work assignments of plans reviewers. Handles correspondence between the customers and plan reviewers. Assigns corrections of e-permits to appropriate staff. Reviews and assigns inspections requests when needed. Verifies that all required inspections have been completed, fees have been paid, and completion of interdepartmental tasks prior to the issuance of the approved plan or permit. Processes plan revisions after e-permits have been issued. Administrative duties to include preparing and maintaining departmental records, correspondence, and e-permit files. Provides assistance to the Department Director and Assistant Director as required. Prepares reports and performs a variety of clerical duties to support department operations. Organizes and maintains departmental records, databases and spreadsheets as instructed. Retrieves files on request. Performs related duties, as assigned. Knowledge, Skills, and Abilities: Good knowledge of office practices and procedures including basic record keeping, operation of standard office equipment including computer equipment, copiers, fax machines and printers. Good knowledge of business letter writing and typing formats. Good knowledge of basic mathematics. Good knowledge of personal computers and Microsoft Office Outlook, Word, Excel and Adobe in addition to permitting database software. Ability to organize and maintain accurate records and files and prepare reports. Ability to communicate clearly and concisely, both orally and in writing. Ability to read, speak and write in English. Good knowledge of English usage, spelling, grammar and punctuation. Ability to perform administrative support work using independent judgment. Ability to use discernment and tact when interacting with others and representing the City. Ability to locate properties on a map using address or folio number. Ability to comprehend and explain zoning and subdivision principles, practices, regulations, codes, and ordinances in clear terms to the general public. Ability to read and interpret minor building plans, zoning and land use maps. Education & Experience Requirements: High school diploma or general education diploma (GED); Associates degree from an accredited college preferred. Minimum of three (3) years related experience issuing permits or providing customer service in a construction office, permitting office or professional office; or any acceptable related combination of training, education and experience. Bilingual abilities (English/Spanish) are a plus. Licenses & Certificates: Must possess and maintain a valid Florida driver's license and satisfactory driving history throughout employment. Permit Technician Certification is a plus or ability to obtain within six (6) months from date of hire. 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. Sufficient physical ability and mobility to work in an office environment; see, hear and talk with the public to verbally communicate and exchange information; read presented documents; write or use keyboard to communicate through written means; on occasion required to climb or balance, stoop, kneel, crouch, twist, reach, bend, squat; operate office equipment requiring repetitive hand movement and fine coordination; lift or carry weight regularly of 10 pounds and on occasion weight of up to 30 pounds; ability to operate a vehicle and to travel to various locations. Work schedule is Monday - Thursday, 7:00 a.m. to 6:00 p.m., Off Fridays

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!

Integrated 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. We've stayed true to our focus of finding qualified and experienced professionals in our specialty areas. Our partner-employers know that they can rely on us to find the right match between their needs and the abilities of our top-tier candidates. By continually exceeding their expectations, we have built successful ongoing partnerships that help us stay true to our commitments of performance and integrity. Our team works hard to deliver a tailored approach for each and every client, critical in matching the right employers with the right candidates. We forge partnerships that are meant for the long term and align skills and cultures. At IRI, we know that our success is directly tied to our clients' success. Job Description 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 analyzes 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. · Caseload: 25-30 reviews per day. This position is 98% telephonic. Qualifications The candidate will work an 8 hour shift that could start between the hours of 8am - 10:30am. Requirements/Certifications: THIS IS A TEMP-TO-PERM POSITION. Caseload: 25-30 reviews per day. The majority of the caseload is via fax. The manager is looking for 3 years of Inpatient Medical experience, 3 years of Utilization experience, Concurrent Review experience and HMO exp. A strong candidate would be familiar with MCG and Interqual. License and Educational requirement: LPN - Licensed Practical Nurse. An Associate's Degree is required for the LPN and the RN - Registered Nurse - A Bachelor's Degree is required for the RN Additional Information All your information will be kept confidential according to EEO guidelines.

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.

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. 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.

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.

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.

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

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

Job Description With two decades of excellence, Kalologie Medspa stands as a premier destination for aesthetic and wellness treatments. Our team of highly trained experts is renowned for their personalized approach, providing safe, effective, and medically-proven treatments that achieve exceptional results. We are proud of our team based culture, with a genuine focus on well-being. As we continue to expand, we remain committed to our core values and a passionate pursuit of excellence. Position Overview: We are seeking experienced Registered Nurses(RN) to perform IV Infusion Therapy at our location inside Club Studio in Miami World Center. You thrive working in a fast-paced environment and are always willing to learn more and strengthen your skills to deliver the best service and results. The ideal candidate would have specialized training in infusion therapy. Key Responsibilities: Prepare and set up the IV infusion. Foster a calming atmosphere and closely monitor the IV administration process. Conduct client consultations to create customized treatment plans and deliver services that meet individual needs and goals. Educate clients on treatment processes, including detailed pre- and post-care instructions. Address client inquiries, respond to their needs, and manage expectations effectively. Ensure client safety and satisfaction throughout all treatments. Promote and suggest relevant retail products and additional services offered by the company. Maintain and sanitize equipment and manage inventory of products. Adhere to established treatment protocols. Keep detailed records, including client charts. Build and maintain a strong client base. Participate in training sessions and meetings as needed. Perform other assigned duties as required. Occasionally travel to other locations for training purposes. Qualifications: Active license as a Registered Nurse (RN), Nurse Practitioner (NP), Physician Assistant (PA) in the state of employment. Minimum of 2 years of relevant experience preferred. Experience in a clinical setting is a plus. Exceptional interpersonal and communication skills, with the ability to effectively interact with clients, colleagues, and managers. Ability to multitask, stay attentive to client needs, and adapt to business requirements. Strong team player with the ability to take initiative and work independently. Availability to work evenings and weekends is required. Kalologie offers a competitive salary with flexible schedules, generous service discounts, and ongoing training opportunities on new techniques, equipment and products. We promote continued growth and development through our rapidly expanding medical aesthetic clinics.

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

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!

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 License and Educational requirement: LCSW, LCPC or RN. A Masters degree is required for ALL licenses EXCEPT for the RN. A Bachelors degree is required for the RNs. Description: 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 analyzes 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 enrollee 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 enrollees clinical information (such as previous treatment, medications, and planned care) in order to promote continuity of care. - Provides information to enrollees, 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 enrollee 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 enrollee 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. Qualifications Requirements/Certifications: THIS IS A TEMP-TO-PERM POSITION. The candidate will work an 8 hour shift that could start between the hours of 8am - 10:30am. Caseload: 25-30 reviews per day. This position is 98% telephonic. Additional Information: The candidate MUST have BH experience. There will be rounds with a Doctor for 15 mins everyday. Travel maybe required to a local hospital with a mileage rate of $0.54/mile. The manager is looking for 3 years of Inpatient Medical experience, 3 years of Utilization experience, Concurrent Review experience and HMO exp. Training will be 3 - 4 weeks long that will include Code of Conduct, Systems App and Shadowing. Credentialing Paperwork will be completed during training. Additional Information Riya Khem Life Science Recruiter Integrated Resources, Inc. IT Life Sciences Allied Healthcare CRO Certified MBE |GSA - Schedule 66 I GSA - Schedule 621I DIRECT # - 732 -844-8721 | (W) # 732-549-2030 - Ext - 311 |(F) 732-549-5549

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.

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.

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 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 Qualifications Current Florida RN License 3+ 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 Additional Information Hours for this Position: M-F 8-5 Advantages of this Opportunity: Competitive salary $28.85/hr - $31.25/hr pending experience Excellent Medical benefits Offered, Medical, Dental, Vision, 401k, and PTO Growth potential Fun and positive work environment

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

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.