$29.05 - $56.64/hr
Essential Job Duties Performs audits in utilization management, care management, member assessment ... May also perform non-clinical system and process audits as needed. Audits for clinical gaps in care ...
$29.05 - $56.64/hr
Essential Job Duties Performs audits in utilization management, care management, member assessment ... May also perform non-clinical system and process audits as needed. Audits for clinical gaps in care ...
$29.05 - $56.64/hr
Essential Job Duties Performs audits in utilization management, care management, member assessment ... May also perform non-clinical system and process audits as needed. Audits for clinical gaps in care ...
$29.05 - $56.64/hr
Essential Job Duties Performs audits in utilization management, care management, member assessment ... May also perform non-clinical system and process audits as needed. Audits for clinical gaps in care ...
$29.05 - $56.64/hr
Essential Job Duties Performs audits in utilization management, care management, member assessment ... May also perform non-clinical system and process audits as needed. Audits for clinical gaps in care ...
$29.05 - $56.64/hr
Essential Job Duties Performs audits in utilization management, care management, member assessment ... May also perform non-clinical system and process audits as needed. Audits for clinical gaps in care ...
$29.05 - $56.64/hr
Essential Job Duties Performs audits in utilization management, care management, member assessment ... May also perform non-clinical system and process audits as needed. Audits for clinical gaps in care ...
$29.05 - $56.64/hr
Essential Job Duties Performs audits in utilization management, care management, member assessment ... May also perform non-clinical system and process audits as needed. Audits for clinical gaps in care ...
$29.05 - $56.64/hr
Essential Job Duties Performs audits in utilization management, care management, member assessment ... May also perform non-clinical system and process audits as needed. Audits for clinical gaps in care ...
$29.05 - $56.64/hr
Essential Job Duties Performs audits in utilization management, care management, member assessment ... May also perform non-clinical system and process audits as needed. Audits for clinical gaps in care ...
Miami, FL · Remote
$275K - $325K/yr
With more than 400 employed and network clinicians and over 100 clinics and network locations of ... Utilization Management Medical Director Oncology Work Location: REMOTE (work from home) California ...
Quick apply
Miami, FL · Remote
$275K - $325K/yr
With more than 400 employed and network clinicians and over 100 clinics and network locations of ... Utilization Management Medical Director Oncology Work Location: REMOTE (work from home) California ...
Manages non-clinical needs of members with chronic illnesses, co-morbidities, and/or disabilities, to ensure cost effective and efficient utilization of long-term services and supports. * At the ...
Manages non-clinical needs of members with chronic illnesses, co-morbidities, and/or disabilities, to ensure cost effective and efficient utilization of long-term services and supports. * At the ...
$29.05 - $56.64/hr
Essential Job Duties • Performs audits in utilization management, care management, member ... May also perform non-clinical system and process audits as needed. • Audits for clinical gaps in ...
$29.05 - $56.64/hr
Essential Job Duties • Performs audits in utilization management, care management, member ... May also perform non-clinical system and process audits as needed. • Audits for clinical gaps in ...
$29.05 - $56.64/hr
Essential Job Duties • Performs audits in utilization management, care management, member ... May also perform non-clinical system and process audits as needed. • Audits for clinical gaps in ...
$29.05 - $56.64/hr
Essential Job Duties • Performs audits in utilization management, care management, member ... May also perform non-clinical system and process audits as needed. • Audits for clinical gaps in ...
$29.05 - $56.64/hr
Essential Job Duties • Performs audits in utilization management, care management, member ... May also perform non-clinical system and process audits as needed. • Audits for clinical gaps in ...
$29.05 - $56.64/hr
Essential Job Duties • Performs audits in utilization management, care management, member ... May also perform non-clinical system and process audits as needed. • Audits for clinical gaps in ...
$29.05 - $56.64/hr
Essential Job Duties • Performs audits in utilization management, care management, member ... May also perform non-clinical system and process audits as needed. • Audits for clinical gaps in ...
$29.05 - $56.64/hr
Essential Job Duties • Performs audits in utilization management, care management, member ... May also perform non-clinical system and process audits as needed. • Audits for clinical gaps in ...
$29.05 - $56.64/hr
Essential Job Duties • Performs audits in utilization management, care management, member ... May also perform non-clinical system and process audits as needed. • Audits for clinical gaps in ...
$29.05 - $56.64/hr
Essential Job Duties • Performs audits in utilization management, care management, member ... May also perform non-clinical system and process audits as needed. • Audits for clinical gaps in ...
$29.05 - $56.64/hr
Essential Job Duties • Performs audits in utilization management, care management, member ... May also perform non-clinical system and process audits as needed. • Audits for clinical gaps in ...
$29.05 - $56.64/hr
Essential Job Duties • Performs audits in utilization management, care management, member ... May also perform non-clinical system and process audits as needed. • Audits for clinical gaps in ...
$29.05 - $56.64/hr
Essential Job Duties • Performs audits in utilization management, care management, member ... May also perform non-clinical system and process audits as needed. • Audits for clinical gaps in ...
$29.05 - $56.64/hr
Essential Job Duties • Performs audits in utilization management, care management, member ... May also perform non-clinical system and process audits as needed. • Audits for clinical gaps in ...
$29.05 - $56.64/hr
Essential Job Duties • Performs audits in utilization management, care management, member ... May also perform non-clinical system and process audits as needed. • Audits for clinical gaps in ...
$29.05 - $56.64/hr
Essential Job Duties • Performs audits in utilization management, care management, member ... May also perform non-clinical system and process audits as needed. • Audits for clinical gaps in ...
$29.05 - $56.64/hr
Essential Job Duties • Performs audits in utilization management, care management, member ... May also perform non-clinical system and process audits as needed. • Audits for clinical gaps in ...
$29.05 - $56.64/hr
Essential Job Duties • Performs audits in utilization management, care management, member ... May also perform non-clinical system and process audits as needed. • Audits for clinical gaps in ...
$29.05 - $56.64/hr
Essential Job Duties • Performs audits in utilization management, care management, member ... May also perform non-clinical system and process audits as needed. • Audits for clinical gaps in ...
$29.05 - $56.64/hr
Essential Job Duties • Performs audits in utilization management, care management, member ... May also perform non-clinical system and process audits as needed. • Audits for clinical gaps in ...
Lake Mary, FL · On-site
Medical
Dental
Vision
Life
Retirement
PTO
The Utilization Management Representative I is responsible for coordinating cases for ... Conducts clinical screening process. * Authorizes initial set of sessions to provider. * Checks ...
Lake Mary, FL · On-site
Medical
Dental
Vision
Life
Retirement
PTO
The Utilization Management Representative I is responsible for coordinating cases for ... Conducts clinical screening process. * Authorizes initial set of sessions to provider. * Checks ...
Tampa, FL · On-site
Medical
Dental
Vision
Life
Retirement
PTO
The Utilization Management Representative I is responsible for coordinating cases for ... Conducts clinical screening process. * Authorizes initial set of sessions to provider. * Checks ...
Tampa, FL · On-site
Medical
Dental
Vision
Life
Retirement
PTO
The Utilization Management Representative I is responsible for coordinating cases for ... Conducts clinical screening process. * Authorizes initial set of sessions to provider. * Checks ...
Saint Petersburg, FL · Hybrid
Medical
Dental
Vision
Life
Retirement
PTO
Manages non-clinical needs of members with chronic illnesses, co-morbidities, and/or disabilities, to ensure cost effective and efficient utilization of long-term services and supports. * At the ...
Saint Petersburg, FL · Hybrid
Medical
Dental
Vision
Life
Retirement
PTO
Manages non-clinical needs of members with chronic illnesses, co-morbidities, and/or disabilities, to ensure cost effective and efficient utilization of long-term services and supports. * At the ...
| Aspect | Utilization Management Non Clinical | Utilization Review Nurse |
|---|---|---|
| Credentials | Certifications like CCM, RN (optional), but primarily non-clinical certifications | RN license, certifications such as CCM or CUC |
| Work Environment | Office-based, administrative setting, telecommuting options | Clinical settings, hospitals, or insurance companies, often with direct patient or provider interaction |
| Employer & Industry Usage | Health insurance companies, managed care organizations | Hospitals, insurance companies, healthcare providers |
| Search & Comparison Intent | Understanding non-clinical roles in utilization management | Clinical review roles involving direct patient care assessment |
Utilization Management Non Clinical roles focus on administrative, policy, and documentation tasks without direct patient care, while Utilization Review Nurses perform clinical assessments to determine care necessity. Both roles are essential in healthcare utilization but differ mainly in clinical involvement and required credentials.
For Utilization Management Non Clinical jobs in Florida, the most frequently searched job titles are:
The top searched job categories for Utilization Management Non Clinical jobs in Florida are:
Cities in Florida with the most Utilization Management Non Clinical job openings:
$29.05 - $56.64/hr
Full-time
Re-posted 14 days ago
8.0
Based on 199 frontline employees who took The Breakroom Quiz
164th of 308 rated insurance
JOB DESCRIPTION Job Summary
Provides support for healthcare services clinical auditing activities. Performs audits for clinical functional areas in alignment with regulatory requirements - ensuring quality compliance and desired member outcomes. Contributes to overarching strategy to provide quality and cost-effective member care.
Essential Job Duties
Performs audits in utilization management, care management, member assessment, behavioral health, and/or other clinical teams, and monitors clinical staff for compliance with National Committee for Quality Assurance, Centers for Medicare and Medicaid Services (CMS), and state/federal guidelines and requirements. May also perform non-clinical system and process audits as needed.
Audits for clinical gaps in care from a medical and/or behavioral health perspective to ensure member needs are being met.
Assesses clinical staff regarding appropriate clinical decision-making.
Reports monthly outcomes, identifies areas of re-training for staff, and communicates findings to leadership.
Ensures auditing approaches follow a Molina standard in approach and tool use.
Maintains member/provider confidentiality in compliance with the Health Insurance Portability and Accountability Act (HIPAA), and professionalism in all communications.
Adheres to departmental standards, policies and protocols.
Maintains detailed records of auditing results.
Assists healthcare services training team with developing training materials or job aids as needed to address findings in audit results.
Meets minimum production standards related to clinical auditing.
May conduct staff trainings as needed. Communicates with quality and/or healthcare services leadership regarding issues identified, and works collaboratively to subsequently resolve/correct.
Required Qualifications
At least 2 years health care experience, with at least 1 year experience in utilization management, care management, and/or managed care, or equivalent combination of relevant education and experience.
Registered Nurse (RN). License must be active and restricted in state of practice.
Strong attention to detail and organizational skills.
Strong analytical and problem-solving skills.
Ability to work in a cross-functional, professional environment.
Ability to work on a team and independently.
Excellent verbal and written communication skills.
Microsoft Office suite/applicable software program(s) proficiency.
Preferred Qualifications
Utilization management, care management, behavioral health and/or long-term services and supports (LTSS) clinical review/auditing experience.
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#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: $29.05 - $56.64 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
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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
