RN, Utilization Management | Utilization Management| Night | Part Time

UF Health; Gainesville (FL); On-site; USD 60,000 - 80,000; Part time

Job summary

UF Health in Gainesville, FL is looking for a part-time Utilization Management Nurse to evaluate patient records and ensure compliance with healthcare guidelines. This role requires coordination with care teams to optimize patient care and resource use.

The ideal candidate will have a current RN license in Florida and at least three years of experience in utilization review or case management. Strong communication and analytical skills are essential to support timely patient discharge and effective treatment planning.

Qualifications

• Current Florida nursing license required as a Registered Nurse (RN).
• Minimum of three years of experience in utilization review or case management.
• Strong knowledge of healthcare utilization guidelines and payer requirements.

Responsibilities

• Evaluate patient medical records for medical necessity and appropriateness.
• Coordinate with healthcare providers and care teams.
• Support effective treatment planning and patient care coordination.

Skills

Utilization management

Patient care coordination

Communication skills

Data analysis

Knowledge of regulatory compliance

Education

Registered Nurse (RN) with current Florida nursing license

Job description

Overview

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

Work Style: Onsite

Location: Gainesville, FL

FTE: Part-Time (.6 FTE)

Schedule: Wednesday – Thursday 7:00 PM – 7:00 AM

Plays a critical role in evaluating patient medical records to ensure the necessity and appropriateness of healthcare services. Involves coordinating with healthcare providers to maintain compliance with utilization management guidelines and optimizing treatment plans for effective patient care and resource utilization. Requires clear communication of authorization decisions and ongoing monitoring to support timely discharge planning. Analyzes utilization data to identify trends and collaborates with interdisciplinary teams to enhance care coordination while ensuring accurate documentation and regulatory compliance.

Responsibilities

• Evaluates patient medical records to determine the medical necessity and appropriateness of healthcare services.
• Coordinates with healthcare providers and care teams to ensure compliance with utilization management guidelines and payer requirements.
• Supports effective treatment planning, patient care coordination, and appropriate resource utilization.
• Communicates authorization decisions and utilization determinations while supporting timely discharge planning efforts.
• Analyzes utilization management data and trends to identify opportunities for improved care coordination and operational efficiency.
• Collaborates with interdisciplinary teams to ensure accurate documentation, regulatory compliance, and quality patient outcomes.

Qualifications

Education & Licensure

• Registered Nurse (RN) with a current Florida nursing license required.

Experience & Skills

• Minimum of three (3) years of experience in utilization review, utilization management, or case management required.
• Knowledge of healthcare utilization guidelines, payer requirements, and regulatory compliance standards.
• Experience evaluating medical necessity, treatment plans, and appropriate levels of care.
• Strong communication and collaboration skills related to authorization determinations and care coordination.
• Demonstrated ability to analyze utilization data, identify trends, and support patient care and discharge planning initiatives.