RN, Utilization Management | Utilization Management | Onsite

UF Health; The Villages (FL); On-site; USD 80,000 - 100,000; Full time

Job summary

UF Health in The Villages, FL is seeking an onsite utilization management RN to evaluate patient records for medical necessity and alignment with guidelines. You will collaborate with providers to optimize treatment plans, document care, and support efficient resource use.

Responsibilities include communicating authorization decisions, monitoring progress for discharge planning, analyzing utilization data, and working with interdisciplinary teams to ensure regulatory compliance and accurate

Qualifications

• Registered Nurse with a Florida license.
• Experience in utilization review, case management, or third-party payer environments.
• Strong knowledge of utilization management guidelines and regulatory requirements.

Responsibilities

• Evaluates patient medical records to determine necessity and appropriateness of healthcare services.
• Coordinates with providers to ensure compliance with utilization management guidelines.
• Supports optimization of treatment plans and resource utilization.
• Communicates authorization decisions and supports discharge planning.
• Analyzes utilization data to identify trends and opportunities for care coordination.
• Collaborates with interdisciplinary teams to ensure accurate documentation and regulatory compliance.

Skills

RN License

Utilization Review

Critical Care

Case Management

Regulatory Compliance

Care Coordination

Communication

Data Analysis

Job description

Overview

Join an onsite clinical team focused on ensuring the right care at the right time for every patient.

• Work Style: Onsite
• Location: The Villages, FL
• FTE: Full-Time (1.0 FTE)
• Schedule: Monday - Friday (occasional weekends required)

Evaluates patient medical records to determine the medical necessity and appropriateness of healthcare services in alignment with utilization management guidelines. Collaborates with healthcare providers to support compliance, optimize treatment plans, and promote efficient resource utilization.

Communicates authorization decisions clearly and monitors patient progress to support timely discharge planning. Analyzes utilization data to identify trends and opportunities for process improvement.

Partners with interdisciplinary teams to enhance care coordination, ensure accurate documentation, and maintain compliance with regulatory and organizational standards.

Responsibilities

Key Responsibilities

• Evaluates patient medical records to ensure the necessity and appropriateness of healthcare services.
• Coordinates with healthcare providers to ensure compliance with utilization management guidelines.
• Supports the optimization of treatment plans to promote effective patient care and appropriate resource utilization.
• Communicates authorization decisions clearly and supports timely discharge planning.
• Analyzes utilization data to identify trends and opportunities to improve care coordination.
• Collaborates with interdisciplinary teams to ensure accurate documentation and regulatory compliance.

Qualifications

Education & Experience:

• Registered Nurse (RN) with a current Florida license required.
• Three (3) years of critical care nursing experience, or
• Five (5) years of medical-surgical nursing experience, or
• Three (3) years of utilization review, case management, or third-party payer experience.

Qualifications

• Active Registered Nurse (RN) license with 3+ years of experience in utilization review or case management.
• Strong knowledge of healthcare utilization management guidelines and regulatory compliance.
• Experience evaluating medical necessity and optimizing treatment plans.
• Excellent communication skills with the ability to clearly convey authorization decisions.
• Ability to analyze utilization data and support effective care coordination.
• Strong organizational skills with the ability to manage multiple priorities simultaneously.
• Ability to work independently and collaboratively with multidisciplinary teams.
• Strong attention to detail and innovative problem-solving skills.
• Flexibility to adjust work hours and days based on departmental needs.

Motor Vehicle Operator Designation:

Employees in this position will not operate vehicles for an assigned business purpose.

Note: Please indicate the appropriate operator designation on the Request for Personnel (RFP) form at the time of submission.

Licensure/Certification/Registration:

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