Utilization jobs in Miami

**Utilization Review Specialist - Exact Billing Solutions (EBS) Lauderdale Lakes, FL - On-site - No Remote** Salary: $55K - $70K Who We Are Exact Billing Solutions is a unique team of revenue cycle management professionals specializing in the substance use disorder, mental health, and autism care fi

At Johnson & Johnson, we believe health is everything. Our strength in healthcare innovation empowers us to build a world where complex diseases are prevented, treated, and cured, where treatments are smarter and less invasive, and solutions are personal. Through our expertise in Innovative Medicine

Current Employees: If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here to log in to Workday to use the internal application process. To learn how to apply for a faculty or staff position, please review this tip sheet . UMHC-SCCC - Business Operatio

Elevance Health

Utilization Management Representative I Location : This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to

Baptist Health is the region’s largest not-for-profit healthcare organization, with 12 hospitals, over 28,000 employees, 4,500 physicians and 200 outpatient centers, urgent care facilities and physician practices across Miami-Dade, Monroe, Broward and Palm Beach counties. With internationally renown

CalOptima

Behavioral Health Utilization Management Medical Case Manager CalOptima Join Us in this Amazing Opportunity The Team You'll Join We are a mission driven community‐based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready

Baptist Health is the region’s largest not-for-profit healthcare organization, with 12 hospitals, over 28,000 employees, 4,500 physicians and 200 outpatient centers, urgent care facilities and physician practices across Miami-Dade, Monroe, Broward and Palm Beach counties. With internationally renown

Baptist Health is the region’s largest not-for-profit healthcare organization, with 12 hospitals, over 28,000 employees, 4,500 physicians and 200 outpatient centers, urgent care facilities and physician practices across Miami-Dade, Monroe, Broward and Palm Beach counties. With internationally renown

Brief Description Miami Jewish Health is one of the largest providers of healthcare and living options for aging adults in the Southeast. We operate Florida PACE (Program of All-Inclusive Care for the Elderly) Centers, the largest PACE program in Florida, which serves as health plan, healthcare prov

Current Employees: If you are a current Staff, Faculty or Temporary employee at the University of Miami, please click here to log in to Workday to use the internal application process. To learn how to apply for a faculty or staff position, please review this tip sheet . CORE JOB SUMMARY The purpose

A company is looking for a Utilization Review Specialist. Key Responsibilities Complete preadmission and concurrent reviews to obtain treatment authorizations and ensure ongoing communication with payors Coordinate peer reviews and manage the provision of Letters of Medical Necessity as needed Suppo

A company is looking for a Utilization Review Coordinator. Key Responsibilities Accesses, triages, and assigns cases for utilization review Enters demographics and utilization review information into claims or clinical management systems Obtains necessary information for utilization review processin

A company is looking for a Utilization Management Nurse, LVN/LPN. Key Responsibilities Conduct timely reviews of inpatient and skilled nursing services to assess medical necessity and appropriateness Collaborate with the Medical Director on complex cases and provide comprehensive clinical summaries

A company is looking for an Inpatient Utilization Management Clinician. Key Responsibilities Conduct concurrent and retrospective inpatient utilization reviews to determine medical necessity and appropriate levels of care Gather and analyze clinical documentation from electronic medical records to s

A company is looking for a Utilization Review & Quality Assurance Specialist. Key Responsibilities Evaluate clinical information and write/review various reports, ensuring compliance with standards Perform quality assurance reviews of peer reports and provide feedback to ensure clarity and professio

The Medical Director of Case Management and Utilization Review leads the hospital specific execution of the Case Management (CM) and Utilization Management (UR) and related activities. The Medical Director functions as the primary physician advisor for the hospital and supervises other Physician Adv

PWC

Industry/Sector Health Services Specialism Operations Management Level Manager Job Description & Summary As an operations consulting generalist at PwC, you will possess a broad understanding of various aspects of operations consulting. You will provide comprehensive guidance and support to clien

Get Well

$65,000 - $75,000 /year

Title: Client Service Manager, Government – Miami, FL Reporting to: Senior Client Service Manager Location: This position will be based onsite at the Miami, FL VA hospital location. Opportunity: If outcomes improvement and patient-centered care are your passion, then we want to speak with you! We’re

Accenture is a leading global professional services company that helps the world's leading businesses, governments and other organizations build their digital core, optimize their operations, accelerate revenue growth and enhance citizen services-creating tangible value at speed and scale. We are a

Elevance Health

A leading health company is seeking a Utilization Management Representative II to manage incoming calls, determine eligibility for healthcare services, and provide clinical support. This role offers virtual work flexibility while requiring occasional in-person training. Ideal candidates have at leas