RN Utilization Management Specialist

UF Health; Leesburg (FL); On-site; USD 55,000 - 96,000; Part time

Job summary

UF Health in Leesburg, FL is seeking a qualified RN to support utilization management by evaluating patient records for medical necessity and coordinating with care teams to meet payer requirements. The role is onsite with a .10 FTE PRN schedule, offering exposure to discharge planning and quality improvement.

You will analyze utilization data, document decisions, and ensure regulatory compliance to optimize patient care and resource use.

Qualifications

• RN with Florida license
• 3+ years in utilization review/management or case management
• Knowledge of payer requirements and regulatory standards

Responsibilities

• Evaluate patient records to determine medical necessity
• Coordinate with care teams to ensure guidelines and payer requirements
• Support treatment planning and discharge planning
• Communicate authorization decisions and determinations
• Analyze utilization data to identify trends and improve coordination
• Ensure documentation and regulatory compliance

Skills

Utilization review

Care coordination

Communication

Regulatory compliance

Education

Florida nursing license

Job description

UF Health in Leesburg, FL is seeking a qualified RN to support utilization management by evaluating patient records for medical necessity and coordinating with care teams to meet payer requirements. The role is onsite with a .10 FTE PRN schedule, offering exposure to discharge planning and quality improvement.

You will analyze utilization data, document decisions, and ensure regulatory compliance to optimize patient care and resource use.