Current jobs related to Licensed Utilization Review II - Tampa FL United States - Elevance Health
-
Licensed Utilization Review II
2 months ago
Tampa, United States Elevance Health Full timeAnticipated End Date: 2024-09-21 Position Title: Licensed Utilization Review II (RN) Job Description: Simply Healthcare Plans, Inc. is a proud member of Elevance Health's family of brands. We are a licensed health maintenance organization with health plans for people enrolled in Medicaid and/or Medicare programs in Florida. Licensed Utilization Review...
-
Licensed Utilization Review Specialist
3 weeks ago
Tampa, FL , USA, United States Elevance Health Full timeJob SummaryWe are seeking a highly skilled Licensed Utilization Review Specialist to join our team at Elevance Health. As a key member of our medical management team, you will play a critical role in ensuring that our members receive the most appropriate and cost-effective care possible.Key ResponsibilitiesConduct thorough reviews of medical necessity and...
-
Licensed Utilization Review Specialist
3 weeks ago
Tampa, Florida, United States Elevance Health Full timeJob SummaryAt Elevance Health, we are seeking a skilled Licensed Utilization Review Specialist to join our team. As a Licensed Utilization Review Specialist, you will play a critical role in ensuring the appropriate and consistent administration of plan benefits through collecting clinical information required to preauthorize services, assess medical...
-
Licensed Utilization Review Specialist
3 weeks ago
Tampa, Florida, United States Elevance Health Full timeJob Summary:As a Licensed Utilization Review Specialist at Elevance Health, you will play a critical role in ensuring that our members receive the most appropriate and cost-effective care. You will work closely with healthcare providers to collect clinical information, assess medical necessity, and apply medical policies and clinical guidelines to make...
-
Utilization Review Clinician- ABA
2 months ago
Miami, FL, United States Centene Corporation Full timeYou could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. ***POSITION IS REMOTE BUT CANDIDATE MUST RESIDE IN STATE OF FLORIDA***Position...
-
Utilization Review RN
1 week ago
Wellston, OK, United States Norman Regional Health System Full timeOverview: The Utilization Review team is comprised of highly skilled Registered Nurses who ensure Norman Regional Health System follows a compliant review process to determine appropriateness of admission. Responsibilities: Job Summary Utilization Review, Utilization Management, Advocacy and Education Clinical Analysis and Data Management Clinical Care...
-
Utilization Review RN
2 weeks ago
Purcell, OK, United States Norman Regional Health System Full timeOverview: The Utilization Review team is comprised of highly skilled Registered Nurses who ensure Norman Regional Health System follows a compliant review process to determine appropriateness of admission. Responsibilities: Job SummaryUtilization Review, Utilization Management, Advocacy and EducationClinical Analysis and Data ManagementClinical Care...
-
Clinical Utilization Review Specialist
3 weeks ago
Tallahassee, FL, United States Centene Corporation Full timeJob Title: Utilization Review Clinician - ABAJoin Centene Corporation, a leading healthcare company, as a Utilization Review Clinician - ABA. In this role, you will play a critical part in ensuring the medical appropriateness of Applied Behavioral Analysis (ABA) services for our members.Key Responsibilities:Evaluate member care and health status before,...
-
Utilization Review Clinician- ABA
2 months ago
Pompano Beach, FL, United States Centene Corporation Full timeYou could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. ***POSITION IS REMOTE BUT CANDIDATE MUST RESIDE IN STATE OF FLORIDA***Position...
-
RN Utilization Review
1 week ago
Columbus, OH, United States Mount Carmel Health System Full timeEmployment Type:Part timeShift:Description:Utilization Review RN, Case ManagementWhy Mount Carmel? With five hospitals, over 60 free-standing outpatient clinics, a college of nursing, a Medicare Advantage plan, and extensive outreach and community wellness programs, Mount Carmel Health System serves more than a million patients in...
-
RN-Utilization Review
7 days ago
Nashville, TN, United States Ascension Full timeDetails Department: Case Management Schedule: Full-Time, Monday-Friday (8:00A - 4:30P) Hospital: Ascension St Thomas Location: Nashville, TN - - - ****TN Nursing License is REQUIREDBenefits Paid time off (PTO) Various health insurance options & wellness plans Retirement benefits including employer match plans Long-term & short-term disability Employee...
-
Licensed Practical Nurse II
4 weeks ago
Venice, FL, United States Sarasota Memorial Health Full timeDepartmentGeneral Surgical Job SummaryThe LPN II implements nursing care for assigned patients. The LPN II assists the RN in the assessment, planning, intervention, and evaluation of nursing care. The LPN II utilizes advance skills in patient care after education and training. Required Qualifications- Require graduation from an accredited school of practical...
-
Development Review Coordinator II
2 weeks ago
Kissimmee, FL, United States Osceola County, FL Full timeJob SummaryThe Development Review Coordinator II is responsible for providing highly specialized coordination of all aspects of incoming project reviews. This role involves participating in the DRC process within the Development Review Department, in coordination with other departments, including representation of DRC, PC, and BCC levels. The Development...
-
RN-Utilization Review
7 days ago
Nashville, TN, United States Ascension Full timeDetails Department: Case ManagementSchedule: Full-Time, Monday-Friday (8:00A - 4:30P)Hospital: Ascension St ThomasLocation: Nashville, TN ****TN Nursing License is REQUIREDBenefits Paid time off (PTO) Various health insurance options & wellness plans Retirement benefits including employer match plans Long-term & short-term disability Employee assistance...
-
Licensed Practical Nurse II
2 months ago
Sarasota, FL, United States Sarasota Memorial Health Full timeDepartmentVascular Access Team Job SummaryThe LPN II implements nursing care for assigned patients. The LPN II assists the RN in the assessment, planning, intervention, and evaluation of nursing care. The LPN II utilizes advance skills in patient care after education and training. Requires at least 1-2 years of experience as an LPN. Looking for experienced...
-
Registered Nurse RN
3 weeks ago
Pensacola, FL, United States Ascension Full timeDetails Department: Utilization Review Schedule: Full time days; 8:00AM-4:30PM Monday-Friday Hospital: Ascension Sacred Heart Pensacola Location: Pensacola, Florida Benefits Paid time off (PTO) Various health insurance options & wellness plans Retirement benefits including employer match plans Long-term & short-term disability Employee assistance...
-
Utilization Review Clinician
6 hours ago
Raleigh, NC, United States Centene Full timeYou could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Performs a clinical review and assesses care related to...
-
Utilization Review Clinician
9 hours ago
Omaha, NE, United States Centene Full timeYou could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Performs a clinical review and assesses care related to...
-
Utilization Management/Quality Review Nurse
11 hours ago
Chicago, IL, United States HireOps Staffing LLC Full timeNurse Liaison I UM & QR Contract to hire, $41/hour, 5 days onsite in Chicago or Naperville. BASIC FUNCTION: This position is responsible for ensuring compliance with the Utilization Management (UM) and Quality Review (QR) functions performed by the Medical Groups/IPAs participating. Evaluates the need for, designs, and implements educational seminars for...
-
Physician Reviewer for Disability Peer Review
3 weeks ago
, FL, United States Dane Street Full timeDane Street is seeking a skilled Physician Reviewer to join our team for disability peer review opportunities. This is a remote/telework position that offers a customized caseload to fit your schedule.As a Physician Reviewer, you will utilize your clinical expertise to review medical records and provide an independent, professional opinion on the claimant's...
Licensed Utilization Review II
2 months ago
Anticipated End Date: 2024-09-21 Position Title: Licensed Utilization Review II (RN) Job Description: Simply Healthcare Plans, Inc. is a proud member of Elevance Health's family of brands. We are a licensed health maintenance organization with health plans for people enrolled in Medicaid and/or Medicare programs in Florida. Licensed Utilization Review II Location: This is a remote position. The selected candidate must reside in the state of Florida. This position requires level 2 background check. Schedule: This position will work a 1st shift from 8:00 am- 5:00 pm (EST), Monday thru Friday. Additional hours or days may be required based on operational needs (holiday rotation). The Licensed Utilization Review II is responsible for working primarily with healthcare providers to help ensure appropriate and consistent administration of plan benefits through collecting clinical information required to preauthorize services, assess medical necessity, out of network services, and appropriateness of treatment setting and applying appropriate medical policies, clinical guidelines, plan benefits, and/or scripted algorithms within scope of licensure. How you will make an impact Primary duties may include, but are not limited to: * Conducts pre-certification, inpatient, retrospective, out of network and appropriateness of treatment setting reviews within scope of licensure by utilizing appropriate medical policies and clinical guidelines in compliance with department guidelines and consistent with the members eligibility, benefits and contract. * Develops relationships with physicians, healthcare service providers, and internal and external customers to help improve health outcomes for members. * Applies clinical knowledge to work with facilities and providers for care-coordination. * May access and consult with peer clinical reviewers, Medical Directors and/or delegated clinical reviewers to help ensure medically appropriate, quality, cost effective care throughout the medical management process. * Educates the member about plan benefits and contracted physicians, facilities and healthcare providers. * Refers treatment plans/plan of care to peer clinical reviewers in accordance with established criteria/guidelines and does not issue medical necessity non-certifications. * Facilitates accreditation by knowing, understanding, and accurately applying accrediting and regulatory requirements and standards. * May lead cross-functional teams, projects, initiatives, and process improvement activities. * May serve as departmental liaison to other areas of the business unit or as a representative on enterprise initiatives. Minimum Requirements: * Requires a HS diploma or equivalent and a minimum of 2 years of clinical or utilization review experience and minimum of 3 years of managed care experience; or any combination of education and experience, which would provide an equivalent background. * Current active unrestricted license or certification as a LPN, LVN, or RN practice as a health professional within the scope of licensure in applicable state(s) or territory of the United States required. Preferred Skills, Capabilities, and Experiences: * Bachelor's degree in nursing is highly preferred. * Current active unrestricted license or certification as a RN practice as a health professional within the scope of licensure in applicable state of Florida. * Minimum of 2 years of Long-Term Care clinical or Long-Term Care utilization review experience and minimum of 3 years of managed care experience is strongly preferred. * Previous Medical Review and/or Prior Authorization/Pre-Certification experience is preferred. * Certification in the American Association of Managed Care Nurses is preferred. * Knowledge of the medical management processes and the ability to interpret and apply member contracts, member benefits, and managed care products is strongly preferred. * Proficient in Microsoft Office For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills. Job Level: Non-Management Non-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. Candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location. 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. 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 elevancehealthjobssupport@elevancehealth.com for assistance.
