COORD - CASE MGMT/UTILIZ REV FULL TIME DAYS

UHS•Palm Beach Gardens, FL

7d•Onsite

About The Position

A Utilization Review (UR) Nurse assesses patient medical records to ensure care is medically necessary, appropriate, and cost-effective, working as a liaison between providers, patients, and payers to secure authorizations, manage denials, and promote efficient resource use, balancing clinical quality with fiscal responsibility through documentation, communication, and adherence to guidelines like InterQual or MCG criteria. They work to balance high-quality care with cost control by reviewing documentation, communicating with healthcare teams, and facilitating proper insurance authorization for services like hospital stays, procedures, or discharges.

Requirements

Graduate of an accredited school of nursing required. BSN preferred.
Acute Care Hospital experience
Strong organization and file management.
Proficiency in office software (MS Office, email, databases).
Excellent written and verbal communication.
Ability to multitask and handle sensitive information.
Acute care clinical experience (typically 3–5 years)
Knowledge of InterQual or MCG
Strong analytical, communication, and documentation skills
Familiarity with CMS, Medicare, Medicaid, and commercial payer rules
Active and current Florida RN license.

Nice To Haves

BSN preferred.

Responsibilities

Assess patient medical records to ensure care is medically necessary, appropriate, and cost-effective.
Work as a liaison between providers, patients, and payers to secure authorizations and manage denials.
Promote efficient resource use.
Balance clinical quality with fiscal responsibility through documentation and communication.
Adhere to guidelines like InterQual or MCG criteria.
Review documentation.
Communicate with healthcare teams.
Facilitate proper insurance authorization for services like hospital stays, procedures, or discharges.