RN Utilization Management & Care Coordination

UF Health; The Villages (FL); On-site; USD 80,000 - 100,000; Full time

Job summary

UF Health in The Villages, FL is seeking an onsite utilization management RN to evaluate patient records for medical necessity and alignment with guidelines. You will collaborate with providers to optimize treatment plans, document care, and support efficient resource use.

Responsibilities include communicating authorization decisions, monitoring progress for discharge planning, analyzing utilization data, and working with interdisciplinary teams to ensure regulatory compliance and accurate

Qualifications

• Registered Nurse with a Florida license.
• Experience in utilization review, case management, or third-party payer environments.
• Strong knowledge of utilization management guidelines and regulatory requirements.

Responsibilities

• Evaluates patient medical records to determine necessity and appropriateness of healthcare services.
• Coordinates with providers to ensure compliance with utilization management guidelines.
• Supports optimization of treatment plans and resource utilization.
• Communicates authorization decisions and supports discharge planning.
• Analyzes utilization data to identify trends and opportunities for care coordination.
• Collaborates with interdisciplinary teams to ensure accurate documentation and regulatory compliance.

Skills

RN License

Utilization Review

Critical Care

Case Management

Regulatory Compliance

Care Coordination

Communication

Data Analysis

Job description

UF Health in The Villages, FL is seeking an onsite utilization management RN to evaluate patient records for medical necessity and alignment with guidelines. You will collaborate with providers to optimize treatment plans, document care, and support efficient resource use.

Responsibilities include communicating authorization decisions, monitoring progress for discharge planning, analyzing utilization data, and working with interdisciplinary teams to ensure regulatory compliance and accurate