RN Case Manager, Utilization Review, PRN - JR248-4
About The Position
Northwest Florida Community Hospital is seeking a PRN Registered Nurse Case Manager to support the Med-Surg department. The position reviews patient admissions and continued stays, coordinates patient care, and helps ensure appropriate use of hospital resources while supporting quality outcomes and compliance with applicable healthcare regulations. The role works with physicians, nursing staff, case management, and other healthcare professionals to support care coordination, utilization review, and potential discharge planning needs. The position also communicates with insurers and third-party payers about authorizations, medical necessity, and continued-stay reviews, and maintains accurate documentation of utilization review activities. Employment is as needed (per diem/PRN) at the hospital in Chipley, Florida. Applicants tentatively selected must complete a criminal history check and pre-employment drug screening. Northwest Florida Community Hospital is an equal opportunity employer and is committed to a workplace free of discrimination and harassment.
Requirements
- Current, active Registered Nurse (RN) license in Florida or a multistate license valid for practice in Florida.
- Previous acute care nursing experience.
- Strong critical-thinking, communication, organizational, and documentation skills.
- Ability to work collaboratively with physicians, nursing staff, and interdisciplinary teams.
Nice To Haves
- Experience in utilization review, case management, discharge planning, or medical necessity review.
- Knowledge of clinical documentation, insurance authorization processes, and payer requirements.
Responsibilities
- Conduct utilization reviews to assess medical necessity, level of care, and appropriateness of hospital admissions and continued stays.
- Review medical records and clinical documentation for compliance with payer requirements and established guidelines.
- Collaborate with physicians, nursing staff, case management, and other healthcare professionals to support effective patient care.
- Identify potential discharge planning needs and assist with coordination of appropriate post-acute services.
- Communicate with insurance companies and third-party payers regarding authorization, medical necessity, and continued-stay reviews.
- Identify opportunities to improve resource utilization, patient outcomes, and length of stay.
- Maintain accurate and timely documentation of utilization review activities.
- Support compliance with hospital policies, regulatory standards, and applicable reimbursement guidelines.
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What This Job Offers
Career Level
Mid Level
Education Level
No Education Listed
