RN, Utilization Management| Day| Full Time
About The Position
The RN, Utilization Management evaluates patient medical records to determine the medical necessity and appropriateness of healthcare services in alignment with utilization management guidelines. The role collaborates with healthcare providers to support compliance, optimize treatment plans, and promote efficient resource utilization. The nurse communicates authorization decisions clearly and monitors patient progress to support timely discharge planning. The role also analyzes utilization data to identify trends and opportunities for process improvement, and partners with interdisciplinary teams to enhance care coordination, ensure accurate documentation, and maintain compliance with regulatory and organizational standards. This is an onsite, full-time position at UF Health Leesburg, with a Monday–Friday schedule and occasional weekends required. Work hours and days may be adjusted based on departmental needs.
Requirements
- Current Florida Registered Nurse (RN) license.
- Three years of critical care nursing experience, or five years of medical-surgical nursing experience, or three years of utilization review, case management, or third-party payer experience.
- Strong knowledge of healthcare utilization management guidelines and regulatory compliance.
- Experience evaluating medical necessity and optimizing treatment plans.
- Excellent communication skills and the ability to clearly convey authorization decisions.
- Ability to analyze utilization data and support effective care coordination.
- Strong organizational skills and the ability to manage multiple priorities simultaneously.
- Ability to work independently and collaboratively with multidisciplinary teams.
- Strong attention to detail and innovative problem-solving skills.
- Flexibility to adjust work hours and days based on departmental needs.
Responsibilities
- Evaluate patient medical records to ensure the necessity and appropriateness of healthcare services.
- Coordinate with healthcare providers to ensure compliance with utilization management guidelines.
- Support the optimization of treatment plans to promote effective patient care and appropriate resource utilization.
- Communicate authorization decisions clearly and support timely discharge planning.
- Analyze utilization data to identify trends and opportunities to improve care coordination.
- Collaborate with interdisciplinary teams to ensure accurate documentation and regulatory compliance.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
