Tampa, FL · Remote
$26.41 - $43/hr
Adheres to utilization management (UM) policies and procedures. Required Qualifications At least 2 ... Registered Nurse (RN). License must be active and unrestricted in state of practice. Ability to ...
Tampa, FL · Remote
$26.41 - $43/hr
Adheres to utilization management (UM) policies and procedures. Required Qualifications At least 2 ... Registered Nurse (RN). License must be active and unrestricted in state of practice. Ability to ...
Tampa, FL · Remote
$107K - $208K/yr
... ) through American Nurses Credentialing Center (ANCC) or American Association of Nurse ... and manage multiple projects. • Ability to think critically and demonstrate solution-oriented ...
Tampa, FL · Remote
$107K - $208K/yr
... ) through American Nurses Credentialing Center (ANCC) or American Association of Nurse ... and manage multiple projects. • Ability to think critically and demonstrate solution-oriented ...
Tampa, FL · Remote
$107K - $208K/yr
Leads and manages team of advanced practice practitioners - focusing on clinical care ... Physician Assistant (PA) or Advanced Practice Registered Nurse (APRN) through American Nurses ...
Tampa, FL · Remote
$107K - $208K/yr
Leads and manages team of advanced practice practitioners - focusing on clinical care ... Physician Assistant (PA) or Advanced Practice Registered Nurse (APRN) through American Nurses ...
We are currently hiring LPNs, RNs, and NPs across all specialties for a wide range of settings, including hospitals, home health, healthtech, and telehealth. Whether you prefer bedside care or remote ...
We are currently hiring LPNs, RNs, and NPs across all specialties for a wide range of settings, including hospitals, home health, healthtech, and telehealth. Whether you prefer bedside care or remote ...
Tampa, FL · On-site +1
$120K - $135K/yr
The Field Service Manager, North Florida for Beckman Coulter Diagnosticsis responsible fordirecting ... We recognize the benefits of flexible, remote working arrangements for eligible roles and are ...
Tampa, FL · On-site +1
$120K - $135K/yr
The Field Service Manager, North Florida for Beckman Coulter Diagnosticsis responsible fordirecting ... We recognize the benefits of flexible, remote working arrangements for eligible roles and are ...
... nursing facilities, assisted living communities, and case managers * Generate qualified referrals ... Conduct daily field visits, calls, and follow-ups with referral partners * Promote home health ...
Quick apply
... nursing facilities, assisted living communities, and case managers * Generate qualified referrals ... Conduct daily field visits, calls, and follow-ups with referral partners * Promote home health ...
Lecanto, FL · On-site +1
$70K/yr
Join Our Team of Remote Hybrid Registered Dietitians at NutraCo! Are you a compassionate and driven ... Managed 401(k) Program - Paid Time Off - Company Paid Holidays - Continuing Education Credits ...
Lecanto, FL · On-site +1
$70K/yr
Join Our Team of Remote Hybrid Registered Dietitians at NutraCo! Are you a compassionate and driven ... Managed 401(k) Program - Paid Time Off - Company Paid Holidays - Continuing Education Credits ...
Tampa, FL · Remote
$85K - $90K/yr
The Associate Medical Editor is a licensed oncology registered nurse, preferably with a master ... Self-motivated, organized, creative, and able to manage, lead, and follow-up on multiple projects ...
Tampa, FL · Remote
$85K - $90K/yr
The Associate Medical Editor is a licensed oncology registered nurse, preferably with a master ... Self-motivated, organized, creative, and able to manage, lead, and follow-up on multiple projects ...
Brooksville, FL · On-site +1
$70K/yr
Join Our Team of Remote Hybrid Registered Dietitians at NutraCo! Are you a compassionate and driven ... Company Managed 401(k) Program * Paid Time Off * Company Paid Holidays * Continuing Education ...
Brooksville, FL · On-site +1
$70K/yr
Join Our Team of Remote Hybrid Registered Dietitians at NutraCo! Are you a compassionate and driven ... Company Managed 401(k) Program * Paid Time Off * Company Paid Holidays * Continuing Education ...
Tampa, FL · Remote
$200K - $320K/yr
... and case management abilities • Excellent academic credentials • J.D. from an ABA-accredited law school required • Active Florida bar admission required Why This Opportunity Fully remote ...
Quick apply
Tampa, FL · Remote
$200K - $320K/yr
... and case management abilities • Excellent academic credentials • J.D. from an ABA-accredited law school required • Active Florida bar admission required Why This Opportunity Fully remote ...
Dunedin, FL · On-site +1
$70K/yr
Join Our Team of Remote Hybrid Registered Dietitians at NutraCo! Are you a compassionate and driven ... Company Managed 401(k) Program * Paid Time Off * Company Paid Holidays * Continuing Education ...
Dunedin, FL · On-site +1
$70K/yr
Join Our Team of Remote Hybrid Registered Dietitians at NutraCo! Are you a compassionate and driven ... Company Managed 401(k) Program * Paid Time Off * Company Paid Holidays * Continuing Education ...
Clearwater, FL · Remote
$50 - $60/hr
Contribute to developing cutting-edge AI systems, while enjoying the flexibility of remote work and ... MDs, PAs, and Nurses. Advantages of contracting with us: * You'll be able to choose which projects ...
Quick apply
Clearwater, FL · Remote
$50 - $60/hr
Contribute to developing cutting-edge AI systems, while enjoying the flexibility of remote work and ... MDs, PAs, and Nurses. Advantages of contracting with us: * You'll be able to choose which projects ...
Tampa, FL · Remote
$50 - $60/hr
Contribute to developing cutting-edge AI systems, while enjoying the flexibility of remote work and ... MDs, PAs, and Nurses. Advantages of contracting with us: * You'll be able to choose which projects ...
Quick apply
Tampa, FL · Remote
$50 - $60/hr
Contribute to developing cutting-edge AI systems, while enjoying the flexibility of remote work and ... MDs, PAs, and Nurses. Advantages of contracting with us: * You'll be able to choose which projects ...
Tampa, FL · Remote
$40 - $44/hr
... management support for obesity-related comorbidities under the supervision of assigned physicians Engage in remote patient monitoring using digital tools (e.g., scales, BG meters, BP monitors ...
Tampa, FL · Remote
$40 - $44/hr
... management support for obesity-related comorbidities under the supervision of assigned physicians Engage in remote patient monitoring using digital tools (e.g., scales, BG meters, BP monitors ...
Tampa, FL · Remote
$40 - $44/hr
... management support for obesity-related comorbidities under the supervision of assigned physicians Engage in remote patient monitoring using digital tools (e.g., scales, BG meters, BP monitors ...
Tampa, FL · Remote
$40 - $44/hr
... management support for obesity-related comorbidities under the supervision of assigned physicians Engage in remote patient monitoring using digital tools (e.g., scales, BG meters, BP monitors ...
Tampa, FL · Remote
$24 - $26/hr
We are seeking a Clinical Intake/Triage Nurse to join our rapidly growing team. JOIN THE RIA HEALTH ... Provide coordination of care, case management, and advocacy when needed and throughout a member ...
Quick apply
Tampa, FL · Remote
$24 - $26/hr
We are seeking a Clinical Intake/Triage Nurse to join our rapidly growing team. JOIN THE RIA HEALTH ... Provide coordination of care, case management, and advocacy when needed and throughout a member ...
Tampa, FL · On-site +1
$29.50 - $39.75/hr
Create and implement targeted nutrition programs for various populations, including those managing ... Remote, must be located in the United States.
Tampa, FL · On-site +1
$29.50 - $39.75/hr
Create and implement targeted nutrition programs for various populations, including those managing ... Remote, must be located in the United States.
Tampa Palms, FL · Remote
$29.50 - $39.75/hr
Our holistic approach to chronic care management is rooted in understanding each patient's unique ... Your work directly contributes to improving lives through proactive, remote care. * Cutting-Edge ...
Tampa Palms, FL · Remote
$29.50 - $39.75/hr
Our holistic approach to chronic care management is rooted in understanding each patient's unique ... Your work directly contributes to improving lives through proactive, remote care. * Cutting-Edge ...
Tampa, FL · On-site +1
$165K - $220K/yr
As Chief Nurse, you will provide program management to ensure coordination of care, including ... by-case-basis.) NOTE: Grandfathering Provision - All persons currently employed in VHA in 0610 ...
Tampa, FL · On-site +1
$165K - $220K/yr
As Chief Nurse, you will provide program management to ensure coordination of care, including ... by-case-basis.) NOTE: Grandfathering Provision - All persons currently employed in VHA in 0610 ...
Our dynamic Medical Management team is seeking a full-time IME Operations Manager (REMOTE) to ... IME & Case Coordination - Coordinate Independent Medical Examinations (IME), Record Reviews, and ...
New
Our dynamic Medical Management team is seeking a full-time IME Operations Manager (REMOTE) to ... IME & Case Coordination - Coordinate Independent Medical Examinations (IME), Record Reviews, and ...
New
$53.9K - $57.1K
2% of jobs
$57.1K - $60.3K
4% of jobs
$60.3K - $63.5K
10% of jobs
$65.3K is the 25th percentile. Wages below this are outliers.
$63.5K - $66.7K
16% of jobs
$66.7K - $69.9K
16% of jobs
The median wage is $70.5K / yr.
$69.9K - $73.1K
12% of jobs
$73.1K - $76.3K
5% of jobs
$79K is the 75th percentile. Wages above this are outliers.
$76.3K - $79.5K
12% of jobs
$79.5K - $82.7K
12% of jobs
$82.7K - $85.9K
9% of jobs
$85.9K - $89.1K
3% of jobs
$53.9K
$73K
$89.1K
| Aspect | Remote Rn Field Case Manager | Remote Rn Utilization Review Nurse |
|---|---|---|
| Certifications | RN license, case management certification often preferred | RN license, certification in utilization review or case management beneficial |
| Work Environment | Field-based, visiting patients and providers remotely | Office-based, reviewing cases and medical records remotely |
| Employer & Industry Usage | Insurance companies, workers' comp, healthcare providers | Insurance companies, managed care organizations, healthcare payers |
| Common Search & Comparison | Remote Rn Field Case Manager vs Remote Rn Utilization Review Nurse |
The Remote Rn Field Case Manager primarily conducts patient visits and manages cases in the field, while the Remote Rn Utilization Review Nurse focuses on reviewing medical necessity and appropriateness of care remotely. Both roles require RN licensure and related certifications, but differ in work environment and daily responsibilities.
$26.41 - $43/hr
Full-time
Posted 22 days ago
8.0
Based on 192 frontline employees who took The Breakroom Quiz
145th of 261 rated insurance
JOB DESCRIPTION
Must reside in Florida
Job Summary
Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care.
Essential Job Duties
Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines.
Analyzes clinical service requests from members or providers against evidence based clinical guidelines.
Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures.
Conducts reviews to determine prior authorization/financial responsibility for Molina and its members.
Processes requests within required timelines.
Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner.
Requests additional information from members or providers as needed.
Makes appropriate referrals to other clinical programs.
Collaborates with multidisciplinary teams to promote the Molina care model.
Adheres to utilization management (UM) policies and procedures.
Required Qualifications
At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience.
Registered Nurse (RN). License must be active and unrestricted in state of practice.
Ability to prioritize and manage multiple deadlines.
Excellent organizational, problem-solving and critical-thinking skills.
Strong written and verbal communication skills.
Microsoft Office suite/applicable software program(s) proficiency.
Preferred Qualifications
Certified Professional in Healthcare Management (CPHM).
Recent hospital experience in an intensive care unit (ICU) or emergency room.
#PJHS3
#LI-AC1
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $26.41 - $43 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
Get the full story on Breakroom
Sourced by ZipRecruiter
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.
Health care and social assistance
10,000+ Employees
Long Beach, CA, US
1980
