RN, Utilization Management | Utilization Management| Variable | PRN

UF Health Central Florida; Leesburg (FL); In loco; USD 52.000 - 78.000; Part-time

Descrizione del lavoro

UF Health Central Florida in Leesburg, FL, is seeking a PRN Utilization Management RN to support the right care at the right time onsite. The role focuses on medical necessity evaluations, coordination with care teams, and discharge planning to optimize resource use.

Qualified candidates will have Florida RN licensure and 3+ years in utilization review or case management, with strong communication and data analysis skills to drive compliant, high-quality patient outcomes.

Competenze

• RN license in Florida required.
• Minimum of three (3) years in utilization review, utilization management, or case management.

Mansioni

• Evaluates patient records to determine medical necessity and appropriateness of services.
• Coordinates with care teams to ensure compliance with utilization guidelines and payer requirements.
• Supports treatment planning, care coordination, and appropriate resource utilization.
• Communicates authorization decisions and utilization determinations for timely discharge planning.
• Analyzes utilization data to identify trends and opportunities for improved care coordination and efficiency.
• Ensures accurate documentation and regulatory compliance across the team.

Conoscenze

Utilization review

Care coordination

Communication

Regulatory compliance

Formazione

RN license (Florida)

Strumenti

Electronic Health Records (EHR)

Descrizione del lavoro

Overview

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

Work Style: Onsite

Location: Leesburg, FL

FTE: PRN (.10 FTE)

Schedule: Variable

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.