RN Utilization Management Specialist

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

Job summary

A healthcare provider in Florida is seeking a Registered Nurse to play a critical role in evaluating patient medical records for healthcare necessity. The ideal candidate will coordinate with healthcare providers, support discharge planning, and analyze utilization data for improved care coordination. Candidates must have an active RN license and 3+ years of relevant experience, showcasing strong communication and organizational skills. This position does not involve operating vehicles for business purposes.

Qualifications

• Three (3) years of critical care nursing, or five (5) years of medical-surgical nursing experience.
• Strong knowledge of healthcare utilization management guidelines.

Responsibilities

• Evaluate patient medical records for healthcare service necessity.
• Coordinate compliance with utilization management guidelines.
• Support optimization of treatment plans.
• Communicate authorization decisions effectively.
• Analyze utilization data for trends.
• Collaborate with interdisciplinary teams.

Skills

Critical care nursing experience

Medical-surgical nursing experience

Utilization review experience

Excellent communication skills

Organizational skills

Problem-solving skills

Education

Active Registered Nurse (RN) license

3+ years of experience in nursing

Job description

A healthcare provider in Florida is seeking a Registered Nurse to play a critical role in evaluating patient medical records for healthcare necessity. The ideal candidate will coordinate with healthcare providers, support discharge planning, and analyze utilization data for improved care coordination. Candidates must have an active RN license and 3+ years of relevant experience, showcasing strong communication and organizational skills. This position does not involve operating vehicles for business purposes.