RN Utilization Management Specialist

UF Health; Florida; On-site; USD 80,000 - 105,000; Full time

Job summary

UF Health in Florida is seeking an experienced RN to support utilization review and case management. You will assess patient records for medical necessity, coordinate with clinicians, and ensure compliant documentation to optimize care and discharge planning.

The role requires 3+ years in utilization review, a current Florida RN license, and strong communication and data analysis skills to identify trends and improve resource utilization within a multidisciplinary team.

Qualifications

• Knowledge of healthcare utilization guidelines and compliance.
• Experience evaluating medical necessity and treatment plans.
• Strong communication skills for authorization decisions.
• Ability to analyze utilization data and support care coordination.

Responsibilities

• Evaluate patient records to ensure necessity and appropriateness of services.
• Coordinate with providers to maintain utilization guidelines compliance.
• Optimize treatment plans for effective patient care and resource use.
• Communicate authorization decisions clearly to support discharge planning.
• Analyze utilization data to identify trends and improve care coordination.

Skills

Utilization guidelines

Medical necessity

Communication skills

Data analysis

Care coordination

Education

Graduate from accredited Nursing school

Job description

UF Health in Florida is seeking an experienced RN to support utilization review and case management. You will assess patient records for medical necessity, coordinate with clinicians, and ensure compliant documentation to optimize care and discharge planning.

The role requires 3+ years in utilization review, a current Florida RN license, and strong communication and data analysis skills to identify trends and improve resource utilization within a multidisciplinary team.