RN, Utilization Management| Day |Full Time

UF Health; The Villages (FL); On-site; USD 75,000 - 105,000; Full time

Job summary

UF Health in Gainesville, FL is seeking an onsite RN for utilization management to ensure medical necessity and appropriate care levels, while coordinating with care teams and payers to support timely discharge planning. The role requires a Florida RN license and at least three years in utilization review, with strong communication skills to liaise with providers and regulators.

You will analyze utilization data, communicate authorization decisions, and drive care coordination and documentation

Qualifications

• RN license registered in Florida.
• Minimum 3 years in utilization review/management or case management.
• Knowledge of utilization guidelines, payer requirements, and regulatory standards.
• Strong communication and collaboration for authorization determinations and care coordination.
• Ability to analyze utilization data, identify trends, and support discharge planning.

Responsibilities

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

Skills

Utilization management

Communication

Collaboration

Data analysis

Education

RN license (FL)

Job description

Make an impact by supporting the right care at the right time through utilization management excellence.

Work Style: Onsite
Location: Gainesville, FL
FTE: Full-Time (1.0FTE)
Schedule: (Days-TBD) 8:00 PM – 6:30PM

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

Responsibilities

Key Responsibilities

• Evaluates patient medical records to determine the medical necessity and appropriateness of healthcare services.
• Coordinates with healthcare providers and care teams to ensure compliance with utilization management 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 efforts.
• Analyzes utilization management 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.

Qualifications

Education & Licensure

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

Experience & Skills

• Minimum of three (3) years of experience in utilization review, utilization management, or case management required.
• Knowledge of healthcare utilization guidelines, payer requirements, and regulatory compliance standards.
• Experience evaluating medical necessity, treatment plans, and appropriate levels of care.
• Strong communication and collaboration skills related to authorization determinations and care coordination.
• Demonstrated ability to analyze utilization data, identify trends, and support patient care and discharge planning initiatives.