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Remote Supervisor Utilization Management Jobs in Florida

Oscar Health

Sr. Quality of Care Review Nurse

Miami, FL · Remote

$83K - $109K/yr

You will report into the Nurse Manager, Quality of Care. Work Location: This is a remote position ... Health plan utilization management experience or case management experience. * Experience in health ...

Monogram Health

Market Physician Executive

Cape Coral, FL · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

This position will be remote within the designated market with occasional in-home patient treatment ... medical utilization management, and risk adjustment. * Current state medical license without ...

Monogram Health

Market Physician Executive

Bonita Springs, FL · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

This position will be remote within the designated market with occasional in-home patient treatment ... medical utilization management, and risk adjustment. * Current state medical license without ...

Monogram Health

Market Physician Executive

Fort Myers, FL · Remote

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

This position will be remote within the designated market with occasional in-home patient treatment ... medical utilization management, and risk adjustment. * Current state medical license without ...

Valeris

Remote Registered Nurse (RN) Case Manager

Orlando, FL · Remote

$50K/yr

  • Medical

  • Dental

  • Vision

  • Retirement

  • PTO

Nurseline triage, Call Center Utilization Management, Call Center Case Management, a plus. * Case management or Clinical Trial Nurse experience, a plus. * Bachelor's degree preferred. * Remote work ...

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Remote Supervisor Utilization Management information

What is the difference between Remote Supervisor Utilization Management vs Remote Utilization Review Nurse?

AspectRemote Supervisor Utilization ManagementRemote Utilization Review Nurse
CredentialsRN, often with management or supervisor certificationsRN, with clinical review certifications
Work EnvironmentSupervises teams, manages utilization processes remotelyPerforms clinical reviews, assesses patient necessity remotely
Employer & Industry UsageHealth insurance companies, managed care organizationsInsurance companies, third-party administrators
Primary FocusOverseeing utilization management operationsConducting clinical utilization reviews

Remote Supervisor Utilization Management roles focus on overseeing utilization management teams and processes, ensuring compliance and efficiency. In contrast, Remote Utilization Review Nurses primarily perform clinical assessments to determine the necessity of services. Both roles require RN credentials but differ in responsibilities and scope within the utilization management field.

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Remote Supervisor Utilization Management jobs near you

Licensed Physician Reviewer-GI (remote)

ChenMed, LLC

Miami, FL • On-site, Remote

$204K - $292K/yr

Part-time

Re-posted 17 days ago

ChenMed rating

8.4

Company rating: 8.4 out of 10

Based on 40 frontline employees who took The Breakroom Quiz

1st of 240 rated social care providers

Job description

We're unique. You should be, too.
We're changing lives every day. For both our patients and our team members. Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts? Do you inspire others with your kindness and joy?
We're different than most primary care providers. We're rapidly expanding and we need great people to join our team.
The Physician Reviewer is the primary physician reviewer for Clinical Appropriateness Reviews cases in our organization. Other duties include advising other physician reviewers and attending daily calls with health plan teams and our local teams assisting with this function and coordinating care for our patients. The position will also participate in Process and Quality improvement in our developing area of Delegated Utilization Management.ESSENTIAL JOB DUTIES/RESPONSIBILITIES:
  • Provides Clinical Appropriateness Reviews by covering the specified territories as assigned:
    • Establish 2-3 cases a day for each market covered (up to 6 markets); ensures attendance on all health plan and local calls; calls in for the weekly Primary Care Provider (PCP) and Skilled Nursing Facility (SNF) meetings covering the assigned territories.
  • Advises other physician reviewers.
  • Other duties as assigned and modified by manager.
KNOWLEDGE, SKILLS AND ABILITIES:
  • Excellent analytical and deductive reasoning skills
  • Good judgement and problem-solving skills
  • Professional and effective communication skills
  • Strong organizational skills
  • Written and verbal fluency in English
  • Proficient in the use of Microsoft Office products such as Outlook, Excel, Word and PowerPoint

EDUCATION AND EXPERIENCE CRITERIA:
  • Graduate from accredited Medical School with a valid, unrestricted license is required
  • Completion of Internal Medicine or Family Practice residency
  • Completion of Fellowship in Gastroenterology
  • Board Certification in residency area
  • Board Certification in Gastroenterology
  • Two (2) years' experience in Hospital medicine preferred
  • At least one (1) year of utilization review experience preferred

PAY RANGE:
$204,761 - $292,515 Salary
The posted pay range represents the base hourly rate or base annual full-time salary for this position. Final compensation will depend on a variety of factors including but not limited to experience, education, geographic location, and other relevant factors. This position may also be eligible for a bonuses or commissions.
EMPLOYEE BENEFITS
https://chenmed.makeityoursource.com/helpful-documents
We're ChenMed and we're transforming healthcare for seniors and changing America's healthcare for the better. Family-owned and physician-led, our unique approach allows us to improve the health and well-being of the populations we serve. We're growing rapidly as we seek to rescue more and more seniors from inadequate health care.
ChenMed is changing lives for the people we serve and the people we hire. With great compensation, comprehensive benefits, career development and advancement opportunities and so much more, our employees enjoy great work-life balance and opportunities to grow. Join our team who make a difference in people's lives every single day.
Current employees, if you want to apply to our internal career site, please click HERE
Current Contingent Worker please see job aid HERE to apply
#LI-Remote

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About ChenMed

Sourced by ZipRecruiter

We're expanding healthcare equity across America. We're already in 15 states with 100+ medical centers. As a rapidly growing, physician-led organization, we have one central focus: rescue any and every senior from a healthcare system that has failed them. Our family of brands include Chen Senior Medical Center, JenCare Senior Medical Center, and Dedicated Senior Medical Center. Recently named a 2021 Best Places To Work and one of the only healthcare companies recognized in Fortune's 2020 "Change The World" list, ChenMed prides itself on creating a culture that enables career growth and promotes inclusion for all.

Industry

Health care and social assistance

Company size

5,001 - 10,000 Employees

Headquarters location

Miami, FL, US

Year founded

1985

Social media

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