Remote Registered Nurse - Utilization Review Location: Fort Myers, FL 33916 Work Arrangement ... The ideal candidate will have strong provider-side Utilization Management experience , along with ...
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Remote Registered Nurse - Utilization Review Location: Fort Myers, FL 33916 Work Arrangement ... The ideal candidate will have strong provider-side Utilization Management experience , along with ...
Remote Registered Nurse - Utilization Review Location: Fort Myers, FL 33916 Work Arrangement ... The ideal candidate will have strong provider-side Utilization Management experience , along with ...
Quick apply
Remote Registered Nurse - Utilization Review Location: Fort Myers, FL 33916 Work Arrangement ... The ideal candidate will have strong provider-side Utilization Management experience , along with ...
Remote Registered Nurse - Utilization Review Location: Fort Myers, FL 33916 Work Arrangement ... The ideal candidate will have strong provider-side Utilization Management experience , along with ...
Quick apply
Remote Registered Nurse - Utilization Review Location: Fort Myers, FL 33916 Work Arrangement ... The ideal candidate will have strong provider-side Utilization Management experience , along with ...
Remote Registered Nurse - Utilization Review Location: Fort Myers, FL 33916 Work Arrangement ... The ideal candidate will have strong provider-side Utilization Management experience , along with ...
Quick apply
Remote Registered Nurse - Utilization Review Location: Fort Myers, FL 33916 Work Arrangement ... The ideal candidate will have strong provider-side Utilization Management experience , along with ...
Setting: Fully Remote - Utilization Review Schedule: Full-Time, Monday-Friday Hours: Standard ... Strong understanding of medical necessity, utilization management, healthcare reimbursement, and ...
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Setting: Fully Remote - Utilization Review Schedule: Full-Time, Monday-Friday Hours: Standard ... Strong understanding of medical necessity, utilization management, healthcare reimbursement, and ...
Setting: Fully Remote - Utilization Review Schedule: Full-Time, Monday-Friday Hours: Standard ... Payer/insurance-only Utilization Management experience is not eligible * Minimum 3 years of acute ...
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Setting: Fully Remote - Utilization Review Schedule: Full-Time, Monday-Friday Hours: Standard ... Payer/insurance-only Utilization Management experience is not eligible * Minimum 3 years of acute ...
Physician Reviewer - Utilization Management
Orlando, FL · Remote
$219K/yr
We're hiring a Physician Reviewer to join our Utilization Management team. Oscar is the first ... This is a remote position, open to candidates who reside in the United States. While your daily ...
Physician Reviewer - Utilization Management
Orlando, FL · Remote
$219K/yr
We're hiring a Physician Reviewer to join our Utilization Management team. Oscar is the first ... This is a remote position, open to candidates who reside in the United States. While your daily ...
Utilization Management Physician (UMP) Remote | Full-Time | Florida Compensation: $240,000 base + bonus Schedule: 40 hours/week Work Model: Remote (on-site meetings in Daytona Beach, FL ) Overview ...
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Utilization Management Physician (UMP) Remote | Full-Time | Florida Compensation: $240,000 base + bonus Schedule: 40 hours/week Work Model: Remote (on-site meetings in Daytona Beach, FL ) Overview ...
Medical Director Utilization Management Oncology
Miami, FL · Remote
$275K - $325K/yr
Utilization Management Medical Director Oncology Work Location ... REMOTE (work from home) California Nevada Arizona Oregon Florida The Medical Director role provides ...
Medical Director Utilization Management Oncology
Miami, FL · Remote
$275K - $325K/yr
Utilization Management Medical Director Oncology Work Location ... REMOTE (work from home) California Nevada Arizona Oregon Florida The Medical Director role provides ...
... utilization management and clinical medical review solutions. We're a leader in Peer and ... This is a flexible, fully remote opportunity requiring just 1-2 hours per week -with no minimum ...
... utilization management and clinical medical review solutions. We're a leader in Peer and ... This is a flexible, fully remote opportunity requiring just 1-2 hours per week -with no minimum ...
... utilization management and clinical medical review solutions. We're a leader in Peer and ... This is a flexible, fully remote opportunity requiring just 1-2 hours per week -with no minimum ...
... utilization management and clinical medical review solutions. We're a leader in Peer and ... This is a flexible, fully remote opportunity requiring just 1-2 hours per week -with no minimum ...
... utilization management and clinical medical review solutions. We're a leader in Peer and ... This is a flexible remote opportunity requiring just 1-2 hours per week -with no minimum commitment.
... utilization management and clinical medical review solutions. We're a leader in Peer and ... This is a flexible remote opportunity requiring just 1-2 hours per week -with no minimum commitment.
... Remote - Any State Medical License ABOUT MRIoA Founded in 1983, Medical Review Institute of America ... utilization management and clinical medical review solutions. We're a leader in Peer and ...
... Remote - Any State Medical License ABOUT MRIoA Founded in 1983, Medical Review Institute of America ... utilization management and clinical medical review solutions. We're a leader in Peer and ...
Utilization Review Nurse
Miami, FL · Remote
$35 - $45.94/hr
This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois ... Previous experience conducting concurrent or inpatient reviews for a managed care plan This is an ...
Utilization Review Nurse
Miami, FL · Remote
$35 - $45.94/hr
This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois ... Previous experience conducting concurrent or inpatient reviews for a managed care plan This is an ...
Licensed Physician Reviewer - Pain Management - PRN - REMOTE
Miami, FL · On-site +1
$204K - $292K/yr
The Physician Reviewer is the primary physician reviewer for Utilization Management (UM) cases in ... Nursing Facility (SNF) meetings covering the assigned territories. * Advises other physician ...
Licensed Physician Reviewer - Pain Management - PRN - REMOTE
Miami, FL · On-site +1
$204K - $292K/yr
The Physician Reviewer is the primary physician reviewer for Utilization Management (UM) cases in ... Nursing Facility (SNF) meetings covering the assigned territories. * Advises other physician ...
BPO Senior Manager
Tampa, FL · Remote
$93K/yr
Strong knowledge of utilization management and appeals processes. * In-depth understanding of NCQA ... Active Registered Nurse (RN) license required. (Not encumbered only) * Florida State-required RN ...
BPO Senior Manager
Tampa, FL · Remote
$93K/yr
Strong knowledge of utilization management and appeals processes. * In-depth understanding of NCQA ... Active Registered Nurse (RN) license required. (Not encumbered only) * Florida State-required RN ...
... revenue cycle management while focusing on delivering exceptional patient care. Our team is ... Remote Position Benefits : • Competitive salary • Health, dental, and vision insurance • ...
... revenue cycle management while focusing on delivering exceptional patient care. Our team is ... Remote Position Benefits : • Competitive salary • Health, dental, and vision insurance • ...
Utilization Review Specialist
Pompano Beach, FL · Remote
$45K - $65K/hr
In this remote role, you'll manage a caseload of 50-75 patients, conducting admission and ... Clinical licensure (LCSW, LMHC, LPC, RN, or equivalent) -- valued but not required * Experience ...
Utilization Review Specialist
Pompano Beach, FL · Remote
$45K - $65K/hr
In this remote role, you'll manage a caseload of 50-75 patients, conducting admission and ... Clinical licensure (LCSW, LMHC, LPC, RN, or equivalent) -- valued but not required * Experience ...
Utilization Management Rep I (contract)
Tampa, FL · Remote
$35K - $40K/yr
Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ... The position is remote. The training will be onsite in the Tampa office for 1-2 weeks. * 5411 Sky ...
Utilization Management Rep I (contract)
Tampa, FL · Remote
$35K - $40K/yr
Refers cases requiring clinical review to a Nurse reviewer. * Responsible for the identification ... The position is remote. The training will be onsite in the Tampa office for 1-2 weeks. * 5411 Sky ...
BPO Clinical Review Senior Specialist
Tampa, FL · Remote
$81K/yr
Position is fully remote only in the state of Florida. Must live in State of Florida and have a ... Strong knowledge of utilization management and appeals processes. * Working knowledge of NCQA ...
BPO Clinical Review Senior Specialist
Tampa, FL · Remote
$81K/yr
Position is fully remote only in the state of Florida. Must live in State of Florida and have a ... Strong knowledge of utilization management and appeals processes. * Working knowledge of NCQA ...
Remote Cvs Utilization Management Nurse information
What is the difference between Remote Cvs Utilization Management Nurse vs Remote Cvs Case Manager?
| Aspect | Remote Cvs Utilization Management Nurse | Remote Cvs Case Manager |
|---|---|---|
| Credentials | RN license, certifications in utilization review | RN license, case management certification |
| Work Environment | Utilization review teams, insurance companies | Patient advocacy, care coordination teams |
| Employer & Industry | Health insurance, managed care organizations | Health insurance, healthcare providers |
Both roles require RN licensure and related certifications, but the Utilization Management Nurse focuses on reviewing medical necessity and approving services, while the Case Manager emphasizes coordinating patient care and discharge planning. Understanding these differences helps job seekers find the right fit within the healthcare and insurance industries.
What are the most commonly searched types of Cvs Utilization Management Nurse jobs in Florida?
The most popular types of Cvs Utilization Management Nurse jobs in Florida are:
What are popular job titles related to Remote Cvs Utilization Management Nurse jobs in Florida?
For Remote Cvs Utilization Management Nurse jobs in Florida, the most frequently searched job titles are:
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Cities in Florida with the most Remote Cvs Utilization Management Nurse job openings:
Remote Registered Nurse - Utilization Review - RRNUR 26-10215
Tampa, FL • Remote
$1.9K/wk
Full-time
Posted 4 days ago
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
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.
- 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.
- 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.