RN — Utilization & Care Management

adventhealth; Orlando (FL); On-site; USD 68,132 - 119,520; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

PTO from Day One

403-B Retirement Plan

Parental Leave

Job summary

AdventHealth in Orlando, FL is seeking an experienced Utilization Management/Case Manager RN. You will monitor admissions, review medical necessity, and secure authorizations while aligning with payer guidelines.

Join a hospital setting that emphasizes whole-person care and professional growth. The role requires strong analytical skills and collaboration with the care team to optimize patient outcomes.

Qualifications

• Must be able to demonstrate knowledge and skills to provide appropriate status recommendations.
• Knowledge of growth, development, and disease states as it relates to life cycles.
• Understanding of notification, reference, and authorization numbers.
• Maintains up-to-date concurrent authorizations for in-house patients in EMR.
• Familiarizes self with authorization requirements for assigned payers.

Responsibilities

• Monitor admissions and perform initial and continued stay medical necessity reviews.
• Manage concurrent and pre-bill denials to prevent loss of reimbursement.
• Collaborate with multidisciplinary care team regarding patient status and denials.
• Build relationships to promote interdisciplinary collaboration.
• Ensure communication of requested clinical information and obtain complete authorization.

Skills

Payer guidelines

Authorization

EMR/EHR

Interdisciplinary communication

Analytical skills

Education

Associate's of Nursing

Bachelor's of Nursing

Tools

EMR/EHR systems

Payer portals

Job description

AdventHealth in Orlando, FL is seeking an experienced Utilization Management/Case Manager RN. You will monitor admissions, review medical necessity, and secure authorizations while aligning with payer guidelines.

Join a hospital setting that emphasizes whole-person care and professional growth. The role requires strong analytical skills and collaboration with the care team to optimize patient outcomes.