RN, Utilization Management| Day| Full Time

UF Health Central Florida; Leesburg (FL); On-site; USD 70,000 - 90,000; Full time

Job summary

UF Health Leesburg is seeking an on-site Utilization Review Nurse to evaluate patient records and determine medical necessity for services in alignment with UM guidelines. You will collaborate with clinicians to support compliant, efficient care and timely discharge planning.

The role requires an active Florida RN license with 3+ years in utilization review or case management, strong communication, and the ability to analyze utilization data to improve care coordination.

Qualifications

• Registered Nurse license required and current in Florida.
• 3+ years of utilization review, case management, or comparable experience.
• Knowledge of utilization management guidelines and regulatory requirements.

Responsibilities

• Evaluate medical records to determine medical necessity and appropriateness of services.
• Collaborate with providers to ensure compliance with guidelines and optimize care plans.
• Communicate authorization decisions clearly and support discharge planning.

Skills

Communication skills

Analytical skills

Team collaboration

Attention to detail

Education

Active RN license

Job description

Overview

(occasional weekends required) Evaluates patient medical records to determine the medical necessity and appropriateness of healthcare services in alignment with utilization management guidelines. Collaborates with healthcare providers to support compliance, optimize treatment plans, and promote efficient resource utilization. Communicates authorization decisions clearly and monitors patient progress to support timely discharge planning. Analyzes utilization data to identify trends and opportunities for process improvement. Partners with interdisciplinary teams to enhance care coordination, ensure accurate documentation, and maintain compliance with regulatory and organizational standards.

Overview

Join an onsite clinical team focused on ensuring the right care at the right time for every patient.

Work Style: Onsite

Location: UF Health Leesburg

FTE: Full-Time (1.0 FTE)

Schedule: Monday - Friday (occasional weekends required)

Evaluates patient medical records to determine the medical necessity and appropriateness of healthcare services in alignment with utilization management guidelines. Collaborates with healthcare providers to support compliance, optimize treatment plans, and promote efficient resource utilization. Communicates authorization decisions clearly and monitors patient progress to support timely discharge planning. Analyzes utilization data to identify trends and opportunities for process improvement. Partners with interdisciplinary teams to enhance care coordination, ensure accurate documentation, and maintain compliance with regulatory and organizational standards.

Responsibilities

Key Responsibilities

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

Qualifications

Education & Experience:

• Three (3) years of critical care nursing experience, or
• Five (5) years of medical-surgical nursing experience, or
• Three (3) years of utilization review, case management, or third-party payer experience.

Qualifications

• Active Registered Nurse (RN) license with 3+ years of experience in utilization review or case management.
• Strong knowledge of healthcare utilization management guidelines and regulatory compliance.
• Experience evaluating medical necessity and optimizing treatment plans.
• Excellent communication skills with the ability to clearly convey authorization decisions.
• Ability to analyze utilization data and support effective care coordination.
• Strong organizational skills with the ability to manage multiple priorities simultaneously.
• Ability to work independently and collaboratively with multidisciplinary teams.
• Strong attention to detail and innovative problem-solving skills.
• Flexibility to adjust work hours and days based on departmental needs.

Motor Vehicle Operator Designation

Employees in this position will not operate vehicles for an assigned business purpose.

Note: Please indicate the appropriate operator designation on the Request for Personnel (RFP) form at the time of submission.

Licensure/Certification/Registration

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