RN, Utilization Management

UF Health; Town of Florida (NY); On-site; USD 90,000 - 120,000; Full time

Benefits offered by this job

Job summary

UF Health is hiring an RN to evaluate patient medical records, ensuring medical necessity and appropriateness of services, while coordinating with providers to optimize care and resource use. You will support discharge planning and work with interdisciplinary teams to improve documentation and regulatory compliance.

We require graduation from an accredited nursing school, an active Florida RN license, and 3+ years in utilization review or case management.

Qualifications

• RN license with 3+ years in utilization review or case management.
• Knowledge of utilization guidelines and regulatory compliance.
• Strong communication for authorization decisions.
• Ability to analyze utilization data to support care coordination.

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.

Skills

Utilization guidelines knowledge

Medical necessity evaluation

Communication for authorization

Care coordination analysis

Education

Nursing degree

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.

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.