Review Nurse- Value Based Services

Evara Health • Clearwater, FL

13d • Onsite

About The Position

Evara Health provides essential, high-quality care to the communities who need it most through 17 centers and mobile units offering primary care, dental, behavioral health, pediatrics, and more. Evara Health is recognized for its innovative, team-based approach, commitment to community health, and dedication to making healthcare accessible for all. Our people fuel our impact. Team members come for the purpose and stay for the supportive culture and strong, community-focused teams. Build a career that goes beyond a job—it changes lives.

Requirements

• Graduate of an accredited LPN or RN program
• Minimum two (2) years of experience as an LPN or RN in healthcare
• Minimum one (1) year of experience as a Utilization Review Nurse or Case Manager
• Active and unencumbered LPN or RN License in the State of Florida
• Current BLS Certification
• This position requires a Level 2 background screening through the Florida Care Provider Background Screening Clearinghouse.

Responsibilities

• Conduct comprehensive reviews of assigned patient populations to assess medical complexity, chronic conditions, and social determinants of health.
• Identify gaps in care using clinical knowledge, internal protocols, and payer guidelines, and determine appropriate medical or non-medical interventions.
• Manage an assigned caseload by performing ongoing outreach to patients, promoting preventive care, encouraging healthy behaviors, and providing education to empower patients in making informed healthcare decisions.
• Maintain accurate and timely documentation of all patient interactions, case notes, and outcome measures within required timeframes (within 24 hours).
• Track and report on quality metrics, ensuring all required measures are completed and submitted appropriately.
• Work closely with providers, care teams, and program leadership to review cases, align on care plans, and support coordinated, patient-centered care.
• Participate in regular case reviews and performance discussions with leadership.
• Schedule and manage patient appointments related to care reviews and value-based initiatives.
• Perform plan-specific activities such as Health Risk Assessments, Annual Wellness outreach, and other required engagement efforts.
• Adhere to all organizational policies, regulatory requirements, and confidentiality standards, including HIPAA and value-based care program guidelines, ensuring the protection of patient and organizational information.
• Utilize analytics tools, HEDIS measures, and reporting systems to monitor performance, close care gaps, and optimize patient outcomes.
• Apply knowledge of clinical documentation, billing, and coding practices to support value-based care initiatives.

Benefits

• Generous Time Off: 15 days of paid time off with an option to cash out unused day
• Holidays: 10 paid holidays and an additional 1 day off for your birthday.
• Wellness Perks: Enjoy a free gym membership to support your health and fitness goals.
• Retirement Planning: 403(b) with 2% employer contribution up to 4% match
• Continuing Education: Tuition reimbursement eligibility which includes $1,500 per year.
• Comprehensive Insurance Plans: Medical, Dental, Vision, Life, Short & Long-Term Disability + extra coverage options.
• Employee Assistance Program (EAP): Confidential counseling, legal & financial advice through EAP

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree