RN: Utilization Management & Care Coordination

UF Health; Town of Florida (NY); On-site; USD 70,000 - 95,000; Full time

Job summary

UF Health in Gainesville, FL is seeking a Registered Nurse to support utilization management. The role evaluates patient medical records to determine medical necessity and appropriateness of services, coordinating with care teams and payers to ensure compliance and optimal resource use.

You will communicate authorization decisions, monitor discharge planning, and analyze utilization data to identify trends and opportunities for improved care coordination.

Qualifications

• RN license in Florida is required.
• Minimum 3 years in utilization review/management or case management.
• Knowledge of utilization guidelines and payer requirements.
• Strong communication and collaboration for authorization determinations.

Responsibilities

• Evaluates patient medical records to determine medical necessity and appropriateness of healthcare services.
• Coordinates with healthcare providers and care teams to ensure compliance with utilization guidelines and payer requirements.
• Supports effective treatment planning, patient care coordination, and appropriate resource utilization.
• Communicates authorization decisions and utilization determinations while supporting timely discharge planning.
• Analyzes utilization data and trends to identify opportunities for improved care coordination and operational efficiency.
• Collaborates with interdisciplinary teams to ensure accurate documentation, regulatory compliance, and quality patient outcomes.

Skills

Communication

Collaboration

Analytical

Education

Florida RN license

Job description

UF Health in Gainesville, FL is seeking a Registered Nurse to support utilization management. The role evaluates patient medical records to determine medical necessity and appropriateness of services, coordinating with care teams and payers to ensure compliance and optimal resource use.

You will communicate authorization decisions, monitor discharge planning, and analyze utilization data to identify trends and opportunities for improved care coordination.