RN, Utilization Management

UF Health; Florida; On-site; USD 80,000 - 105,000; Full time

Job summary

UF Health in Florida is seeking an experienced RN to support utilization review and case management. You will assess patient records for medical necessity, coordinate with clinicians, and ensure compliant documentation to optimize care and discharge planning.

The role requires 3+ years in utilization review, a current Florida RN license, and strong communication and data analysis skills to identify trends and improve resource utilization within a multidisciplinary team.

Qualifications

• Knowledge of healthcare utilization guidelines and compliance.
• Experience evaluating medical necessity and treatment plans.
• Strong communication skills for authorization decisions.
• Ability to analyze utilization data and support care coordination.

Responsibilities

• Evaluate patient records to ensure necessity and appropriateness of services.
• Coordinate with providers to maintain utilization guidelines compliance.
• Optimize treatment plans for effective patient care and resource use.
• Communicate authorization decisions clearly to support discharge planning.
• Analyze utilization data to identify trends and improve care coordination.

Skills

Utilization guidelines

Medical necessity

Communication skills

Data analysis

Care coordination

Education

Graduate from accredited Nursing school

Job description

Overview

Plays a critical role in evaluating patient medical records to ensure the necessity and appropriateness of healthcare services. Involves coordinating with healthcare providers to maintain compliance with utilization management guidelines and optimizing treatment plans for effective patient care and resource utilization. Requires clear communication of authorization decisions and ongoing monitoring to support timely discharge planning. Analyzes utilization data to identify trends and collaborates with interdisciplinary teams to enhance care coordination while ensuring accurate documentation and regulatory compliance.

Onsite

Shift

Monday - Friday, 3-11PM

Responsibilities

Evaluates patient medical records to ensure necessity and appropriateness of healthcare services.

• Coordinates with healthcare providers to maintain compliance with utilization management guidelines.
• Optimizes treatment plans for effective patient care and resource utilization.
• Communicates authorization decisions clearly and supports timely discharge planning.
• Analyzes utilization data to identify trends and improve care coordination.
• Collaborates with interdisciplinary teams to ensure accurate documentation and regulatory compliance.

Qualifications

Required Education

Graduate from an accredited Nursing school

Required experience

Registered Nurse (RN) license with 3+ years experience in utilization review or case management

Necessary Skills

• Knowledge of healthcare utilization guidelines and compliance
• Experience evaluating medical necessity and treatment plans
• Strong communication skills for authorization decisions
• Ability to analyze utilization data and support care coordination

License Requirement

Registered Nurse (RN) with a current Florida nursing license required.