RN Utilization Management Orlando

AdventHealth • Orlando, FL

411d

About The Position

The Utilization Management (UM) Registered Nurse (RN) plays a critical role in analyzing patient records to assess the legitimacy of hospital admissions, treatments, and the appropriate level of care. This position leverages clinical expertise and the XSOLIS Cortex platform to make informed recommendations and document findings according to departmental and regulatory standards. The UM RN is also responsible for denial avoidance strategies and effective communication with multidisciplinary teams to ensure timely and appropriate management of claims.

Requirements

• Current and valid license to practice in Florida as a Registered Nurse (ADN or BSN) required.
• Minimum three years acute care clinical nursing experience required.
• Minimum two years Utilization Management experience, or equivalent professional experience.
• Excellent interpersonal communication and negotiation skills.
• Strong analytical, data management, and computer skills.
• Strong organizational and time management skills.

Nice To Haves

• Bachelor of Science in Nursing or other related BS or BA in addition to Nursing.
• Clinical experience in an acute care facility greater than five years.
• Minimum four years Utilization Management within an acute care setting.
• Experience working in electronic health records for at least two years.

Responsibilities

• Monitor admissions and perform initial patient reviews within 24 hours of admission.
• Perform pre-admission status recommendations in Emergency Department or elective procedure settings as assigned.
• Maintain thorough knowledge of payer guidelines and processes for initiating authorizations.
• Document all benefits, authorization requirements, and collection notes clearly on accounts.
• Work collaboratively with physicians, nursing, and other members of the multidisciplinary care team.
• Utilize advanced conflict resolution skills to ensure timely resolution of issues.
• Facilitate communication to third-party payors and other relevant information to the care team.
• Complete all required documentation in the Cortex platform and in the electronic health record.

Benefits

• Benefits from Day One
• Paid Days Off from Day One
• Debt-free Education (Certifications and Degrees without out-of-pocket tuition expense)

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Hospitals
• Education Level: Bachelor's degree