RN Utilization Management Specialist

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

Job summary

UF Health Central Florida is seeking an experienced registered nurse to support utilization management. The role evaluates medical records to confirm necessity and appropriateness of services, coordinates with care teams, and communicates authorization decisions to support timely discharge planning.

You will analyze utilization data, identify trends, and collaborate with interdisciplinary teams to ensure compliance with guidelines and high-quality patient outcomes.

Qualifications

• RN with current Florida license.
• Minimum three years in utilization review/management.
• Knowledge of payer requirements and regulatory standards.
• Strong communication and collaboration skills for authorization decisions.

Responsibilities

• Evaluates patient records to determine medical necessity and appropriateness of services.
• Coordinates with care teams to ensure compliance with utilization guidelines.
• Supports treatment planning, patient care coordination, and resource utilization.
• Communicates authorization decisions and supports discharge planning.
• Analyzes utilization data to identify trends and improve care coordination.
• Works with interdisciplinary teams to ensure accurate documentation and compliance.

Skills

Utilization review

Care coordination

Regulatory compliance

Data analysis

Education

RN license FL

Job description

UF Health Central Florida is seeking an experienced registered nurse to support utilization management. The role evaluates medical records to confirm necessity and appropriateness of services, coordinates with care teams, and communicates authorization decisions to support timely discharge planning.

You will analyze utilization data, identify trends, and collaborate with interdisciplinary teams to ensure compliance with guidelines and high-quality patient outcomes.