RN, Utilization Management Lead | Utilization Management| Day Full Time

UF Health; Gainesville (FL); On-site; USD 85,000 - 110,000; Full time

Job summary

UF Health in Gainesville is seeking an RN Utilization Lead to coordinate utilization review activities and ensure authorized payment for services, reporting to the Director.

This onsite role requires Florida RN licensure, 2 years utilization review experience in hospital or payer settings, knowledge of DRGs and coding, and strong communication and computer skills; schedule Thursday-Sunday, 5:30 AM - 4:00 PM.

Qualifications

• RN with current Florida license and at least two years of utilization review experience in a hospital setting.
• Knowledge of DRGs, Federal and State guidelines, and payer policies; coding knowledge preferred.
• Strong written and verbal communication skills; ability to type and use a computer proficiently.

Responsibilities

• Coordinate UR activities in accordance with the UR plan and applicable guidelines.
• Assist the Director with operational logistics in their absence.

Skills

Strong communication

Computer proficiency

Education

Florida RN license

Job description

Overview

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

RN Utilization Lead under the general supervision of the Director, is responsible for department coordination of utilization, other review activities to ensure payment for services is authorized and an active and effective utilization management program is maintained.

Work Style: Onsite
Location: Gainesville, FL
FTE: Full-time (1.00 FTE)
Schedule: Thursday-Sunday - 5:30 AM - 4:00 PM

Responsibilities

Responsible to perform all duties accordance with the utilization review (UR) plan, Federal and State guidelines, as well as TJC standards. Is also responsible for operational logistics in the absence of the Director.

Qualifications

Minimum Education and Experience Requirements:

Registered nurse (RN) with current Florida license with a minimum of two (2) years experience performing utilization review in a hospital setting, for a third party payer or other review agency or organization. Knowledge of diagnostic related groups (DRGs), Federal and State guidelines, commercial and other payer groups and coding preferred. Must possess strong written and verbal communication skills. Ability to type and use a computer proficiently required.

Licensure/Certification/Registration: Registered Nurse.