Current jobs related to Utilization Review Clinician - MIAMI - Centene
-
Miami, Florida, United States Jackson Health Full timeDepartment: Jackson Memorial Hospital - Utilization Review Case Management (two openings)Address: 1611 NW 12 Ave, Miami, FL 33136Shift Details: 8:00 am - 4:30 pm, Monday-Friday with weekends occasionally (primarily remote)Why Jackson Memorial Hospital: Jackson Memorial Hospital is the flagship hospital for Jackson Health System and it has been a beacon of...
-
Clinical Coordinator
3 months ago
Miami, United States Jackson Health System Full timeJOB DESCRIPTION Department: Jackson Memorial Hospital - Utilization Review Case Management (two openings) Address: 1611 NW 12 Ave, Miami, FL 33136 Shift Details: 8:00 am - 4:30 pm, Monday-Friday with weekends occasionally (primarily remote) Why Jackson Memorial Hospital: Jackson Memorial Hospital is the flagship hospital for Jackson Health System and...
-
Miami, United States Jackson Health Full timeDepartment: Jackson Memorial Hospital - Utilization Review Case Management (two openings)Address: 1611 NW 12 Ave, Miami, FL 33136Shift Details: 8:00 am - 4:30 pm, Monday-Friday with weekends occasionally (primarily remote)Why Jackson Memorial Hospital:Â Jackson Memorial Hospital is the flagship hospital for Jackson Health System and it has been a beacon of...
-
Registered Nurse Case Manager
1 week ago
Miami, United States Public Health Trust of Dade Co Full timeDepartment: Public Health Trust of Dade Co - Case Management, Utilization ReviewShift Details:Per Diem, Day Shift, 8:00 am-4:30 pm (Remote work available during weekdays, 4 shifts per month)About Public Health Trust of Dade Co: The Public Health Trust of Dade County is dedicated to providing exceptional healthcare services and community support. With a...
-
Miami, Florida, United States Baptist Health South Florida Full timeBaptist Health South Florida is the region's largest not-for-profit healthcare organization with 12 hospitals, more than 27,000 employees, 4,000 physicians, and 200 outpatient centers, urgent care facilities, and physician practices spanning across Miami-Dade, Monroe, Broward, and Palm Beach counties. Baptist Health has internationally renowned centers of...
-
Miami, United States Public Health Trust of Dade Co Full timeDepartment: Jackson Memorial Hospital- Case Management, Utilization Review Address: 1611 NW 12 Ave, Miami, FL 33136 Shift details: Per Diem, Day Shift, 8:00 am-4:30 pm (Local remote, available to work during the week, 4 shifts per month) Why Jackson Memorial Hospital: Jackson Memorial Hospital is the flagship hospital for Jackson Health System and it has...
-
Miami, United States Public Health Trust of Dade Co Full timeDepartment: Jackson Memorial Hospital - Utilization Review Case Management Leadership Address: 1611 NW 12 Ave., Miami, FL 33136 Shift details: 8:00 - 4:30 PM, Monday - Friday (remote position, must live within one hour from facility) Why Jackson Memorial Hospital: Jackson Memorial Hospital is the flagship hospital for Jackson Health System and it has been a...
-
Miami, Florida, United States Jackson Health Full timeDepartment: Jackson Memorial Hospital - Utilization Review Case Management LeadershipAddress: 1611 NW 12 Ave., Miami, FL 33136Shift details: 8:00 - 4:30 PM, Monday - Friday (remote position, must live within one hour from facility) Why Jackson Memorial Hospital: Jackson Memorial Hospital is the flagship hospital for Jackson Health System and it has been a...
-
Miami, United States Jackson Health Full timeDepartment: Jackson Memorial Hospital - Utilization Review Case Management LeadershipAddress: 1611 NW 12 Ave., Miami, FL 33136Shift details: 8:00 - 4:30 PM, Monday - Friday (remote position, must live within one hour from facility)Â Why Jackson Memorial Hospital:Â Jackson Memorial Hospital is the flagship hospital for Jackson Health System and it has...
-
Clinician 1 (Phoenix)
2 weeks ago
Miami, United States Camillus House Full time $56,000Job DescriptionJob DescriptionJOB TITLE: Clinician 1 (Full-Time)Job Details: Under the direction of the Director of Behavioral Health, the Phoenix Clinician will provide clinical services to survivors of human trafficking. Services will include intakes, biopsychosocial assessments, treatment plans and reviews, referrals, individual and group therapy, crisis...
-
Miami, United States Jackson Health Full timeDepartment: Jackson Memorial Hospital- Case Management, Utilization Review Address: 1611 NW 12 Ave, Miami, FL 33136Shift details: Per Diem, Day Shift, 8:00 am-4:30 pm (Local remote, available to work during the week, 4 shifts per month)Why Jackson Memorial Hospital: Jackson Memorial Hospital is the flagship hospital for Jackson Health System and...
-
Underground Utility Superintendent
1 month ago
Miami, United States Roadway Construction, LLC Full timeJob DescriptionJob DescriptionRoadway Construction, LLC is a leading construction firm specializing in civil construction, with a focus on underground utility projects. We are dedicated to delivering high-quality infrastructure solutions on time and within budget. Our team values professionalism, collaboration, and a strong commitment to excellence.Position...
-
Consulting Utility Forester/ Utility Arborist
3 weeks ago
Miami, United States Atlas Field Services Full timeJob DescriptionJob DescriptionAtlas Field Services is actively scouting for Consulting Utility Foresters/ Utility Arborists to join our team as full-time employees. We are looking to fill this role in the following areas: Miami-Dade area. Who are we? We’re dedicated to the growth of our employees. We truly believe in your development. For those who show...
-
Consulting Utility Forester/ Utility Arborist
1 month ago
Miami, United States Atlas Field Services Full timeJob DescriptionJob DescriptionAtlas Field Services is actively scouting for Consulting Utility Foresters/ Utility Arborists to join our team as full-time employees. We are looking to fill this role in the following areas: Miami-Dade area. Who are we? We’re dedicated to the growth of our employees. We truly believe in your development. For those who show...
-
Consulting Utility Forester/ Utility Arborist
3 months ago
Miami, United States Atlas Field Services Full timeJob DescriptionJob DescriptionAtlas Field Services is actively scouting for Consulting Utility Foresters/ Utility Arborists to join our team as full-time employees. We are looking to fill this role in the following areas: Miami-Dade area. Who are we? We’re dedicated to the growth of our employees. We truly believe in your development. For those who show...
-
Managed Care Coord
1 month ago
North Miami Beach, United States Elevance Health Full timeLocation: The ideal candidate will live within 50 miles of a Florida Elevance Health Pulse Point office Shift: Monday – Friday; 8:00am – 7:00pm; some weekends; Schedule will flex The Managed Care Coordinator – RN Clinician is responsible for overall management of member’s case within the scope of licensure; provides supervision and direction to...
-
Nurse Utilization Management Senior
1 day ago
Miami, United States Elevance Health, Inc. Full timeJob SummaryWe are seeking a highly skilled Senior Registered Nurse to join our Utilization Review and Management team at Elevance Health, Inc. As a key member of our team, you will be responsible for reviewing and managing patient care to ensure optimal outcomes and efficient use of healthcare resources.Key ResponsibilitiesConduct thorough reviews of patient...
-
Chief of Public Utilities Management
1 week ago
Miami, United States City of North Miami Beach, FL Full timeSalary: $131, $174,869.82 Annually Location: North Miami Beach, FL Job Type: Full-Time Department: Public Utility - NMB Water FLSA: Exempt Position OverviewThis role encompasses significant managerial and complex professional administrative responsibilities, focusing on the strategic planning, organization, staffing, direction, and oversight of the City's...
-
Accounts Receivable Specialist
1 month ago
Miami, United States Denovo Review Full timeJob DescriptionJob DescriptionNational well established AV rated full service law firm focusing in practice areas that include government, insurance, labor and employment and litigation is seeking an Accounts Receivable Specialist to join their team. The AR Specialist will support the administration of collection activities for assigned clients, practice...
-
Miami, United States Jackson Health Full timeDepartment: Jackson Memorial Hospital - CCC Case Management Utilization ReviewAddress: 1611 NW 12 Ave, Miami, FL 33136Shift details: Full time, Days Why Jackson Memorial Hospital: Jackson Memorial Hospital is the flagship hospital for Jackson Health System and it has been a beacon of medical excellence and community care for more than a century....
Utilization Review Clinician
1 month ago
You 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.
THERE ARE 3 POSITIONS AVAILABLE/BUILDING A NEW PROGRAM.
THESE POSITIONS ARE REMOTE. QUALIFIED APPLICANTS WILL RESIDE IN THE STATE OF FLORIDA, AND THE WORK SCHEDULE IS MONDAY-FRIDAY, 8AM - 5PM; NO HOLIDAYS, NO ON-CALL, NO WEEKENDS.
THESE ROLES WILL BE SUPPORTING BEHAVIORAL HEALTH UTILIZATION MANAGEMENT FOR MEDICAID.
Position Purpose: Performs a clinical review and assesses care related to mental health and substance abuse. Monitors and determines if level of care and services related to mental health and substance abuse are medically appropriate.
- Evaluates member’s treatment for mental health and substance abuse before, during, and after services to ensure level of care and services are medically appropriate
- Performs prior authorization reviews related to mental health and substance abuse to determine medical appropriateness in accordance with regulatory guidelines and criteria
- Performs concurrent review of behavioral health (BH) inpatient to determine overall health of member, treatment needs, and discharge planning
- Analyzes BH member data to improve quality and appropriate utilization of services
- Provides education to providers members and their families regrading BH utilization process
- Interacts with BH healthcare providers as appropriate to discuss level of care and/or services
- Engages with medical directors and leadership to improve the quality and efficiency of care
- Formulates and presents cases in staffing and integrated rounds
- Performs other duties as assigned
- Complies with all policies and standards
ADDITIONAL RESPONSIBILITIES FOR THIS NEW PROGRAM:
The UM role will be focusing on outlier management review of provider records with an overall objective of:
- Helping facilities to improve documentation
- Appropriate application of medical necessity
- Adherence to billing guidelines
Beyond the regular responsibilities listed above, the role will:
- Review full medical records submitted by the facilities evaluating strengths/opportunities in their assessments, TX planning, and case notes
- Validate time billed aligns with documentation in the records
- Ensure providers are moving members through treatment to promote recovery and resiliency and addressing SDoH needs
- Compile all findings into a Clinical Summary that is concisely documented
- Develop collaborative relationships with facilities engaged in the program and provide findings and develop performance improvement plan
- Partner with the Health Plan leaders on outcomes, as well as SIU if FWA activities are identified
Education/Experience: Requires Graduate of an Accredited School Nursing or Bachelor's degree and 2 – 4 years of related experience.
License to practice independently, and/or have obtained the state required licensure as outlined by the applicable state required.
Master’s degree for behavioral health clinicians required.
Clinical knowledge and ability to review and/or assess treatment plans related to mental health and substance abuse preferred.
Knowledge of mental health and substance abuse utilization review process preferred.
Experience working with providers and healthcare teams to review care services related to mental health and substance abuse preferred.
License/Certification:
- LCSW- License Clinical Social Worker required or
- LMHC-Licensed Mental Health Counselor required or
- LPC-Licensed Professional Counselor required or
- Licensed Marital and Family Therapist (LMFT) required or
- Licensed Mental Health Professional (LMHP) required or
- RN - Registered Nurse - State Licensure and/or Compact State Licensure required
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
