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Flex Schedule Remote Utilization Review Jobs in Florida

Oscar Health

Utilization Review Nurse

Miami, FL · Remote

$35 - $45.94/hr

You will report into the Supervisor, Utilization Review. Work Location ... This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois;

Guardian Recovery

UR COORDINATOR

Delray Beach, FL · On-site +1

$60K - $70K/yr

The Utilization Review Coordinator (UR Coordinator) is responsible to perform the process of ... scheduled meetings between hospital and insurance doctors. * Manage and perform the processes for ...

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All JobsUtilization Review JobsFlex Schedule Remote Utilization Review JobsFlex Schedule Remote Utilization Review Jobs in Florida

Flex Schedule Remote Utilization Review information

What is the difference between Flex Schedule Remote Utilization Review vs Flex Schedule Remote Case Manager?

AspectFlex Schedule Remote Utilization ReviewFlex Schedule Remote Case Manager
Primary RoleReview healthcare services for medical necessity and appropriatenessCoordinate patient care, develop care plans, and facilitate services
CredentialsTypically requires nursing, medical, or healthcare-related certificationsOften requires nursing, social work, or healthcare certifications
Work EnvironmentRemote, independent review setting, often within insurance or healthcare companiesRemote or hybrid, involving direct patient interaction and care coordination
Industry UsageCommon in insurance, healthcare, and utilization management sectorsCommon in healthcare, insurance, and patient advocacy sectors

Flex Schedule Remote Utilization Review focuses on evaluating medical necessity remotely, while Flex Schedule Remote Case Manager involves coordinating patient care and services. Both roles often require healthcare certifications and are performed remotely, but their core responsibilities differ in review versus patient management.

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Cities in Florida with the most Flex Schedule Remote Utilization Review job openings:

Flex Schedule Remote Utilization Review jobs near you

Remote Registered Nurse - Utilization Review - RRNUR 26-10215

Tampa, FL • Remote

Compu-Vision - Healthcare
See more jobs at Compu-Vision - Healthcareexternal

$1.9K/wk

Full-time

Posted 3 days ago

New

Job description

Remote Registered Nurse – Utilization Review

Location: Fort Myers, FL 33916
Work Arrangement: Remote
Duration: Contract - 13 Weeks
Schedule: Monday–Friday, 8:00 AM–4:30 PM
Weekend: Every 5th weekend rotation
Radius Requirement: 50-mile radius rule applies — travelers only

Position Overview

We are seeking an experienced Registered Nurse – Utilization Review for a remote Utilization Management position. The ideal candidate will have strong provider-side Utilization Management experience, along with hands-on experience using Dragonfly and Epic.

This role requires an experienced RN who can independently perform utilization review activities in a remote environment and effectively collaborate with providers and healthcare teams.

Key Responsibilities
  • Perform Utilization Review and Utilization Management activities in a provider-side healthcare environment.
  • Review clinical documentation to determine medical necessity and appropriate levels of care.
  • Apply established clinical criteria, policies, and guidelines to utilization decisions.
  • Collaborate with providers, physicians, case management teams, and other healthcare professionals.
  • Review patient records and clinical information using Epic EMR.
  • Utilize Dragonfly for utilization management activities.
  • Identify potential gaps in care and escalate issues appropriately.
  • Maintain accurate and timely documentation of utilization review activities.
  • Communicate effectively with clinical and administrative teams.
  • Support organizational quality, compliance, and utilization management objectives.
  • Float to sister campuses when required.
Required Qualifications
  • Active Registered Nurse (RN) license.
  • Minimum 2 years of relevant experience.
  • Provider-side Utilization Management experience required.
    • Payer-only Utilization Management experience does not qualify.
  • Dragonfly experience required.
  • Epic EMR experience required.
  • CCM or CMCN certification required.
  • Strong clinical assessment, analytical, and documentation skills.
  • Comfortable working independently in a remote environment.
  • Strong computer skills and ability to work effectively with remote technology.
  • Must have access to a personal computer/laptop; equipment is not provided.
  • Prior travel nursing experience highly preferred.
  • Degree accreditation verification required, or 5 years of qualifying experience.
Additional Requirements
  • Must be willing to participate in an every 5th weekend rotation.
  • Must meet the 50-mile radius rule and qualify as a traveler.
  • Floating to sister campuses may be required.
  • Must be comfortable working remotely with minimal supervision.
  • Excellent communication and organizational skills required.