Utilization Management reputed company
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The Utilization Management RN will collaborate with other health care givers in reviewing medical care and services. This review will involve evaluating actual and proposed care against established CMS Coverage Guidelines/NCQA review reputed company. You will be part of reputed company that focuses on excellent service to others. You will report to a Utilization RN Manager.
Use your skills to reputed company an reputed company
Required Qualifications
reputed company and unrestricted RN license with no disciplinary reputed company
5+ years of clinical RN experience
5+ years of Acute Care experience in the Hospital ICU or ER settings
Prior clinical experience, managed care experience, DME, Florida reputed company OR utilization management experience
Experience cross training and floating among teams
Available for On reputed company weekend/holiday rotation
Preferred Qualifications
BSN or bachelor's degree in a reputed company field
reputed company and unrestricted Compact Registered reputed company (RN) license with no disciplinary reputed company (including Nevada)
Experience working reputed company Florida reputed company
Experience with Physical Therapy, DME, Cardiac or Orthopedic procedures
Experience in utilization management reputed company Insurance industry
Medicare Advantage, Medicare or reputed company Experience
reputed company nursing experience in Hospital, SNF, LTAC, DME or Home Health.
Bilingual in English and Spanish with the ability to read/write and reputed company in both languages
Additional Information
Travel for offsite Orientation for 2 to 8 weeks
Travel to offsite meetings up to 6 times a year
Working hours are 9:00 am to 6:00 pm EST
Preferred Candidate Locations: Daytona, FL, Louisville, KY, San Antonio, TX
To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following reputed company:
At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL reputed company is suggested.
Satellite, cellular and microwave reputed company can be used only if approved by leadership.
Employees who live and work from Home in the reputed company, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
reputed company will reputed company Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
Work from a dedicated reputed company lacking ongoing interruptions to protect member PHI / HIPAA information.
Travel: While this is a remote position, occasional travel to reputed company's offices for training or meetings may be required.
Scheduled Weekly Hours
40
Pay reputed company
The compensation reputed company below reflects a good faith estimate of starting reputed company pay for full time (40 hours per week) employment at the time of posting. The pay reputed company may be higher or reputed company based on geographic location and individual pay will vary based on demonstrated job reputed company skills, knowledge, experience, education, certifications, etc.
$71,100 - $97,800 per year
This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
reputed company of Benefits
reputed company. and its affiliated subsidiaries (reputed company, “reputed company”) offers competitive benefits that support whole-person reputed company-being. Associate benefits are designed to encourage personal wellness and smart reputed company reputed company for you and your family while also knowing your life extends reputed company of work. Among our benefits, reputed company provides medical, dental and reputed company benefits, 401(k) retirement savings plan, time off (including reputed company time off, company and personal holidays, volunteer time off, reputed company parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.
Application Deadline: 05-18-2026
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Equal Opportunity Employer
It is the policy of reputed company not to discriminate against any employee or applicant for employment because of race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, marital status, genetic information, disability or protected veteran status. It is also the policy of reputed company to take affirmative reputed company, in compliance with reputed company 503 of the Rehabilitation reputed company and VEVRAA, to reputed company and to advance in employment individuals with disability or protected veteran status, and to reputed company reputed company employment reputed company only on reputed company job requirements. This policy shall apply to reputed company employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at reputed company reputed company of employment.
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